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  • Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,
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Well-Being Inventory (WBI) Version date: 2019 Reference: Vogt, D., Taverna, E., Nillni, Y. I., Booth, B., Perkins, D. F., Copeland, L. A., Finley, E. P., Tyrell, F. A., & Gilman, C. L. (2019). Development and validation of a tool to assess military veterans’ status, functioning, and satisfaction with key aspects of their lives. Applied Psychology: Health and Well-Being, 11(2), 328-349.

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Page 1: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Late-Onset Stress Symptomatology

(LOSS) Scale

Version date 2007

Reference King L A King D W Vickers K Davison E H amp Spiro A I (2007) Assessing late-onset stress symptomatology among aging male combat veterans Aging amp Mental Health 11 175-191 doi10108013607860600844424 [Measurement instrument] Available from httpswwwptsdvagov

Late-Onset Stress Symptomatology

(LOSS) Scale

Version date 2007

Reference King L A King D W Vickers K Davison E H amp Spiro A I (2007) Assessing late-onset stress symptomatology among aging male combat veterans Aging amp Mental Health 11 175-191 doi10108013607860600844424 [Measurement instrument] Available from httpswwwptsdvagov

Well-Being Inventory (WBI)

Version date 2019

Reference Vogt D Taverna E Nillni Y I Booth B Perkins D F Copeland L A Finley E P Tyrell F A amp Gilman C L (2019) Development and validation of a tool to assess military veteransrsquo status functioning and satisfaction with key aspects of their lives Applied Psychology Health and Well-Being 11(2) 328-349

Note to Test Administrators

Please note that this document includes WBI items along with suggested instructions to include with WBI item sets Guidance for test administrators is provided throughout the document and should not be included when administering WBI measures to respondents As indicated in the manual that accompanies this measurement tool separate item sets may be extracted from the full inventory and administered separately WBI measures may be administered via paper-and-pencil web or telephone If the full inventory is administered via paper-and-pencil it is important to explain to test-takers that some sections may not be relevant for them and that they can skip these sections (for example individuals who are not parents should not be asked to complete parental functioning items) In addition items that are denoted as contextual items are not part of the WBI scoring and do not need to be administered to generate WBI measure scores Further details on the WBI and its scoring are available in the WBI manual

Participant ID

Well-Being Inventory Instructions This inventory contains questions regarding your experiences in the key life domains of vocation (work education) finances health and social relationships Please follow the instructions that are provided at the beginning of each section and select the most appropriate response Please be open and honest in your responses There are no right or wrong answers

SECTION 1 VOCATION (WORK AND EDUCATION)

SECTION 1A

In this section you will be asked about your work experiences

A1 What is your current employment status Working for pay Not working for pay but actively looking for paid work Not working for pay and not looking for paid work

ADMINISTRATOR ASK OF ALL THOSE WHO INDICATED THEY WORK FOR PAY

A2 In a typical week how many hours do you work for pay

A3 Do you have more than one paid job Yes No

A4 Which best describes your primary employer For-Profit Business (either public or private) Non-Proft Organization including tax exempt and charitable organizations State or Local Government organization such as public school fire department police department or other public service Federal Government organization such as Department of Veterans Affairs You are self-employed running your own business Other (please specify)

A5 Which best describes your primary field of work Agriculturefarming fishing forestry mining oilgas extraction Construction Facilities amp operations management (for example building and grounds keeping landscaping installation repairs maintenance operations and cleaning) Manufacturing of products (for example food beverages carpet fabric textile apparel tobacco paper toys motor vehicles)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 1 of 23

Participant ID

Transportation amp warehouse (for example aviation specialists including pilots and controllers postal service and delivery logistics couriers driver moving materials factory worker packing and distribution) Government public administration amp military (for example military or combat personnel national security or international afairs consultants or contractors and other government and support personnel) Police fire or other protective services (for example safety officer security correctional officer) Retail sales amp customer care (for example cashier customer service car sales real estate including rentalleasingselling broker landlord or other sales-related work) Hospitality service amp food management (for example housekeeping cook food preparation and service bartender server) Administration (for example human resources project management stafngemployment services and other ofce and administrative support personnel) Personal care (for example hairdresser cosmetologist barber ftness trainer and other personal services) Education amp other training-related work (for example teacher professor librarian academic advisor professional coach and other educational support services) Community amp social services (for example individual and family service provider child day care provider religious services including pastor clergy priest and other church ministry personnel) Arts entertainment media amp recreation (for example performing arts art galleries sports centers amusement and gambling industries) Computer information technology amp other technical services (for example newspaper or software publisher telecommunications data processing broadcasting computer design advertising) Healthcare practitioner therapist or support staff ( for example physician dentist chiropractor counselor nurse EMT residential care specialist) Architecture engineering amp science professionals Legal services (for example lawyer clerk or other legal work) Business amp financial operations (for example banking accounting auditing compliance officers claims processor quality assurance management financial and insurance services) Other (Please specify)

A6 Which best describes your position within your feld If you are not sure please make your best guess

Entry-level Mid-level Upper-level

A7 How long have you been in your current job (If you have more than one job please respond to this question with respect to your primary job)

years months

Well-Being Inventory (05 August 2019) National Center for PTSD Page 2 of 23

Participant ID

ADMINISTRATOR ASK OF EVERYONE

A8 Do you do any of the following types of unpaid work Mark all that apply I do not do any unpaid work Full-time care of children under the age of 18 Full-time care of an adult (for example spouseparentdisabled child over 18) Full-time homemaker without full-time child or elder care responsibilities Volunteer work (excluding time spent helping friends relatives andor neighbors)

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT WORKING FOR PAY BUT ACTIVELY LOOKING FOR PAID WORK IN A1

A9 What is the main reason you have not been working for pay Laid off Fired Quit my previous job Was unable to work due to medical problems Was in school or other training program Other reason (please specify)

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT WORKING FOR PAY AND NOT LOOKING FOR PAID WORK IN A1

A10 What is the main reason you are not looking for paid work Unable to work because of an injury or illness Unable to work because of an ongoing physical health condition or disability Unable to work because of an ongoing mentalemotional condition or disability Unable to find work Retired from the workforce Full-time homemaker andor caregiver In schooltraining Not interested in paid employment Other reason (please specify)

ADMINISTRATOR ASK OF ALL THOSE WHO INDICATED THAT THEY VOLUNTEER IN A8

A11 In a typical week how many hours of unpaid volunteer work do you do

A12 What type(s) of organization(s) do you volunteer for Mark all that apply Civic political professional or international Educational school or youth service Environmental or animal care Hospital or other health organization Public safety emergency services Religious

Well-Being Inventory (05 August 2019) National Center for PTSD Page 3 of 23

Participant ID

Social or community service Sport hobby cultural arts Veteran service organization Other (please specify)

A13 What type(s) of volunteer work do you do Mark all that apply Coach referee or supervise sports teams Tutor or teach Mentor youth or peers Usher greeter or minister Collect prepare distribute or serve food Fundraise or sell items to raise money Provide counseling medical care fire or protective services Provide general office services Provide professional or management assistance including serving on a board or committee Engage in music performance or other artistic activities Engage in general labor andor supply transportation to people Other (please specify)

SECTION 1B

ADMINISTRATOR ASK OF THOSE WHO INDICATE WORKING FOR PAY VOLUNTEERING OR CAREGIVING HOMEMAKING IN A1ampA8

Please answer the next questions with respect to the PRIMARY WORK you have done over the last 3 months For fulltime homemakers andor unpaid caregivers meal preparation household maintenance andor child-rearing may be considered your work For volunteers without paid employment volunteer work is considered your work

Over the last 3 months please indicate how often

Never Rarely Sometimes Often Most

or all of the time

B1 You completed your work when expected (for example attending work regularly completing tasks on time)

1 2 3 4 5

B2 You went above and beyond in your work (for example completing required tasks ahead of schedule taking on extra responsibilities)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 4 of 23

Participant ID

Over the last 3 months please indicate how often

Never Rarely Sometimes Often Most

or all of the time

B3 You maintained positive relationships with others in your work setting (for example avoiding confict when possible being patient with coworkers)

1 2 3 4 5

B4 The quality of your work was excellent

1 2 3 4 5

SECTION 1C

ADMINISTRATOR ASK OF THOSE WHO INDICATE WORKING FOR PAY IN A1

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

C1 Your pay and benefits 1 2 3 4 5

C2 Your work environment (for example people you work with work setting)

1 2 3 4 5

ADMINISTRATOR ASK OF THOSE WHO INDICATE WORKING FOR PAY VOLUNTEERING OR CAREGIVINGHOMEMAKING IN A1ampA8

Please answer the next questions with respect to the PRIMARY WORK you have done over the last 3 months For fulltime homemakers andor unpaid caregivers please note that meal preparation household maintenance andor child-rearing are considered your work For volunteers volunteer work is considered your work

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

C3 The kind of work you do 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 5 of 23

Participant ID

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

C4 How much your work contributions are valued

1 2 3 4 5

C5 Your ability to advance your vocational goals in your current role

1 2 3 4 5

C6 Your ability to apply your skills and knowledge to your work

1 2 3 4 5

SECTION 1D

In this next section you will be asked about your educational and training experiences

D1 Are you currently pursuing additional education or attending a trade or technicalvocational school (excluding on-the-job training)

Yes full-time (12 or more credits of coursework if in university setting) Yes part-time (less than 12 credits of coursework if in university setting) No

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

D2 What type of additional education or training are you pursuing High school diploma GED Technicalvocational training (for example carpentry computer programming medical technician training) Taking undergraduate courses but not enrolled in an undergraduate program Associatersquos degree (for example AA AS) Bachelorrsquos degree (for example BA BS) Taking graduate courses but not enrolled in a graduate program Masterrsquos degree (for example MA MS MEng MEd MSW MBA) Doctorate degree (for example PhD EdD) Professional degree beyond a bachelorrsquos degree (for example MD DDS DVM LLB JD)

D3 Which of the following best describes your primary feld of study in y our current education or training

Arts and humanities (for example English art history journalism) Biological sciences (for example biology environmental science) Business (for example accounting fnance)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 6 of 23

Participant ID

Education (for example elementary education special education) Computer-related (for example computer science information technology) Engineering (for example chemical or mechanical engineering) Physical science (for example chemistry statistics) Health science (for example nursing veterinary health technology) Social science (for example social work psychology) Technicalvocational training (please specify) Other (please specify)

ADMINISTRATOR ASK OF EVERYONE

D4 What is the highest degree or level of education you have completed Less than high school Some high school but no diploma or GED High school diploma GED Post-high school vocational or technical training Some college credit no degree Associatersquos degree (for example AA AS) Bachelorrsquos degree (for example BA BS) Masterrsquos degree (for example MA MS MEng MEd MSW MBA) Doctorate degree (for example PhD EdD) Professional degree beyond a bachelorrsquos degree (for example MD DDS DVM LLB JD)

SECTION 1E

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

Over the last 3 months of your education or training please indicate how often

Never Rarely Sometimes Often Most

or all of the time

E1 You completed all required courseworktraining activities

1 2 3 4 5

E2 You went above and beyond in your educational activities (for example completing assignments ahead of schedule participating in educational activities outside of class)

1 2 3 4 5

E3 You did your part to create a positive learning environment (for example contributing to discussions showing appreciation for othersrsquo viewpoints)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 7 of 23

Participant ID

Over the last 3 months of your education or training please indicate how often

Never Rarely Sometimes Often Most

or all of the time

E4 The quality of your coursework training activities was excellent

1 2 3 4 5

SECTION 1F

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

Over the last 3 months of your education or training how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

F1 The quality of your education or training experience

1 2 3 4 5

F2 The extent to which your education or training is advancing your career goals

1 2 3 4 5

F3 Your learning environment (for example teachers and other students educational setting)

1 2 3 4 5

SECTION 2 FINANCES

In the next section we ask about your fnancial cir cumstances Please remember that all information you provide is completely confden tial and will be used to better understand your fnancial w ell-being Also if you are not sure how to answer some of these questions please provide your best guess

In this set of questions your household refers to you other earners who share the majority of expenses and those who depend on this income (for example children or elders)

SECTION 2G

ADMINISTRATOR ASK OF EVERYONE

G1 Are you able to pay for all necessary expenses each month such as mortgagerent debt payments and groceries

Well-Being Inventory (05 August 2019) National Center for PTSD Page 8 of 23

Participant ID

Yes No

G2 Does your household have at least 3 months of your typical income set aside in case of an unexpected fnancial ev ent

Yes No

G3 Does your household have the insurance coverage you andor your family would need if an unexpected financial event were to occur (for example disability insurance property insurance and or life insurance)

Yes No

G4 Has your household begun to set aside money for retirement Yes No

G5 Is your household more than one month behind on your debt payments (for example mortgage or credit card)

No my household is not more than one month behind in debt payments Yes my household is over one month behind in debt payments Not applicable - my household does not have any debt

G6 Are you currently concerned that you will lose your housing and be unable to find stable alternative housing

Yes No

ADMINISTRATOR ASK OF EVERYONE

G7

G8

How many people are supported by your HOUSEHOLD income including yourself your significant other (if you have one) and anyone else partially or fully supported by this income whether or not they live with you

What is your current living situation Rent an apartment house or room Own an apartment or house Live with a friend or relative and not paying rent Live in a dormitory at school Live in a medical or assisted living facility such as a hospital or rehab center Live in transitional housing (for example a halfway house) Live in a car on the street or in a homeless shelter

Well-Being Inventory (05 August 2019) National Center for PTSD Page 9 of 23

Participant ID

Somewhere else (fll-in

ADMINISTRATOR ASK OF THOSE WHO INDICATED THEY WORK FOR PAY IN A1

G9 Please provide your expected annual SALARY before taxes are taken out If you do not know your salary please indicate how much you expect to earn per hour (before taxes) If you do not know the answer please make your best guess

ANNUAL SALARY (before taxes)

-OR-

HOURLY PAY RATE (before taxes)

ADMINISTRATOR ASK OF EVERYONE

G10 Please provide an estimate of your HOUSEHOLDrsquoS yearly income before taxes are taken out Include all sources of income including salary as well as any disability payments real estate income and any other sources of income from all earners in your household If you do not have other sources of income and you are the only earner in your household this may be the same as your salary If you do not know the answer please make your best guess

$

ADMINISTRATOR ASK OF EVERYONE

G11 Approximately how much money does your household have readily available (for example in cash and savings) to cover a financial emergency such as loss of a job If you do not know the answer make your best guess

$

G12 Approximately how much does your HOUSEHOLD pay towards debt and housing expenses PER MONTH (for example mortgagerent bills credit card debt student loans etc)

$

ADMINISTRATOR ASK OF EVERYONE

SECTION 2H

Well-Being Inventory (05 August 2019) National Center for PTSD Page 10 of 22

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most or all of the time

H1 Followed a budget 1 2 3 4 5

H2 Compared prices when purchasing a product or service

1 2 3 4 5

H3 Kept a written or electronic record of your spending

1 2 3 4 5

H4 Been late in paying a bill 1 2 3 4 5

H5 Had credit card debt that you did not pay of each mon th

1 2 3 4 5

H6 Spent more than you could afford on clothing entertainment and other extras

1 2 3 4 5

H7 Contributed part of each paycheck (or other income) to a retirement account such as a 401k or IRA

1 2 3 4 5

H8 Contributed part of each paycheck (or other income) to a personal savings account

1 2 3 4 5

SECTION 2I

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I1 Your ability to pay for necessities 1 2 3 4 5

I2 Your ability to afford extras (for example vacation dinner out)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 11 of 22

Participant ID

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I3 The amount of savings you have 1 2 3 4 5

I4 The amount of debt you have 1 2 3 4 5

SECTION 3 CURRENT HEALTH

In this next section you will be asked about your current physical and emotionalmental health

SECTION 3J

ADMINISTRATOR ASK OF EVERYONE

J1 Do you have an ongoing physical health condition illness or disability (for example high blood pressure pain)

Yes No

J2 Do you have an ongoing mentalemotional health condition illness or disability (for example depression anxiety)

Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE A PHYSICAL HEALTH PROBLEM IN J1 OR A MENTAL HEALTH PROBLEM IN J2

J3 What ongoing physical or mentalemotional health conditions illnesses or disabilities do you have Mark all that apply

High blood pressure or other heart problem High cholesterol Diabetes requiring insulin other medication or special diet Obesity Sleep problem or disorder Chronic pain or pain related disorder (for example knee back migraines)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 12 of 23

Participant ID

Arthritis A hearing condition that is not correctable Alcohol or drug (including prescription drugs) abusedependence Posttraumatic stress disorder Depression Anxiety disorder (for example panic disorder generalized anxiety disorder)Other chronic physical or mental health problem 1 (please specify) Other chronic physical or mental health problem 2 (please specify) Other chronic physical or mental health problem 3 (please specify)

ADMINISTRATOR ASK OF EVERYONE

J4 Do you have healthcare coverage (for example employer-provided health insurance Medicaid) Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATED THAT THEY HAVE HEALTHCARE COVERAGE IN J4

J5 Which of the following best describe your main sources of healthcare coverage Employer-provided health insurance (could be from your current or former employer a family memberrsquos current or former employer or a union) A plan you purchased through a healthcare exchange (for example Healthcaregov State exchange Obamacare etc) TRICARE VA Medicaid Medicare Other government assisted health plan Something else (please specify)

SECTION 3K

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K1 Eaten a generally healthy diet (for example low fat limited sugar adequate servings of fruits and vegetables)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 13 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K2 Gotten at least 2 hours and 30 minutes of moderate physical activity OR 1 hour and 15 minutes of vigorous activity each week

1 2 3 4 5

K3 Done muscle strengthening exercises at least two days per week

1 2 3 4 5

K4 Gotten quality sleep 1 2 3 4 5

K5 Had sexual intercourse without a condom with more than one person or with a person you did not know

1 2 3 4 5

K6 Used tobacco andor nicotine products (for example cigarettes cigars vape)

1 2 3 4 5

K7 Used alcohol in a way that put your health at risk (for example blacking out driving drunk)

1 2 3 4 5

K8 Used drugs (including prescription drugs) in a way that put your health at risk (for example losing memory or consciousness driving under the infuence)

1 2 3 4 5

K9 Completed recommended medical care (for example physical exams)

1 2 3 4 5

K10 Maintained personal cleanliness (for example personal care household chores)

1 2 3 4 5

K11 Spent time doing things that you enjoy

1 2 3 4 5

K12 Spent time doing things that you find personally meaningful

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 14 of 23

Participant ID

SECTION 3L

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

L1 Your physical health 1 2 3 4 5

L2 Your emotionalmental health 1 2 3 4 5

L3 Your health care 1 2 3 4 5

SECTION 4 SOCIAL RELATIONSHIPS

In this next section you will be asked about your romantic relationship involvement

SECTION 4M

ADMINISTRATOR ASK OF EVERYONE

M1 What is your current marital status

Never married Married - first and only marriage Married - second or later marriage Separated Divorced Widowed

ADMINISTRATOR ASK OF THOSE WHO DID NOT INDICATE MARRIED IN M1

M2 Are you currently in a romantic relationship Currently in a relationship and living as a couple Currently in a relationship but not living as a couple Not currently in a relationship

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 15 of 23

Participant ID

M3 How long have you been married or in your current relationship years months

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT MARRIED ON M1 AND NOT IN A RELATIONSHIP ON M2

M4 Which of the following is true with respect to your romantic relationship status I would like to be in a relationship I prefer not to be in a relationship at this time

SECTION 4N

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Over the last 3 months how often have you done the following in your romantic relationship

Never Rarely Sometimes Often Most

or all of the time

N1 Provided your significant other with the emotional support they sought

1 2 3 4 5

N2 Shared your intimate thoughts and feelings

1 2 3 4 5

N3 Done your fair share of day-to-day tasks (for example grocery shopping errands planning activities)

1 2 3 4 5

N4 Initiated leisure time activities that both you and your signifcan t other enjoy

1 2 3 4 5

N5 Made ef ort to work through disagreements respectfully

1 2 3 4 5

N6 Expressed interest andor willingness to engage in regular sexual or physical intimacy

1 2 3 4 5

SECTION 4O

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 16 of 23

Participant ID

Everybody has aspects of their relationship that make them more or less happy Over the last 3 months how satisfied have you been with your significant otherrsquos contribution to the following aspects of your romantic relationship

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

O1Emotional closeness (for example sharing personal thoughts and feelings)

1 2 3 4 5

O2Companionship (for example doing enjoyable activities together)

1 2 3 4 5

O3Sexual and physical intimacy (for example holding hands or having sex)

1 2 3 4 5

O4 Intellectual connection (for example having many things to talk about)

1 2 3 4 5

O5Security (for example being able to trust and depend on partner)

1 2 3 4 5

O6Division of day-to-day tasks (for example your partnerrsquos contribution to chores and planning activities)

1 2 3 4 5

In this next section you will be asked about your parenting experiences

SECTION 4P

P1 Are you a parent or have you served in a parenting role during the past three months Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P2 Do you have children who are age 18 or younger Yes No

Well-Being Inventory (05 August 2019) National Center for PTSD Page 17 of 23

Participant ID

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P3 How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities) Enter a number on each line write 0 if you do not have any children in that age category

Number of Children

Under 5 years old

Age 5 through 12 years old

Age 13 through 18 years old

Age 19 through 26

27 years +

ADMINISTRATOR ASK OF THOSE WHO DO NOT INDICATE HAVING CHILDREN IN P1

P4 Which of the following is true with respect to your parenting status I would like to be a parent now I prefer not to be a parent at this time

SECTION 4Q

ADMINISTRATOR ASK OF ALL THOSE WHO HAVE CHILDREN UNDER 18 IN P2

Please answer the following questions with regard to children 18 or under for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 18 of 23

Participant ID

All parents have strengths and weaknesses Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

Q1Provided a healthy environment for your child(ren) (for example preparing healthy meals caring for their health keeping them safe)

1 2 3 4 5

Q2Been a good example for your child(ren) (for example being respectful during disagreements with others taking good care of your own health)

1 2 3 4 5

Q3Been actively involved in your child(ren)rsquos activities (for example regularly attending sporting and school events giving your full attention during time together)

1 2 3 4 5

Q4Met your child(ren)rsquos needs for physical affection and emotional support (for example giving them hugs being sympathetic to their problems)

1 2 3 4 5

Q5Been able to successfully manage your child(ren)rsquos unique challenges (for example efectively disciplining children)

1 2 3 4 5

SECTION 4R

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

Please answer the following questions with regard to ALL children for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 19 of 23

Participant ID

Parenting can be both rewarding and challenging How satisfed have you been with the following aspects of your parenting experiences over the last 3 months

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

R1 How close you are with your child(ren)

1 2 3 4 5

R2 How much enjoyment you get from parenting

1 2 3 4 5

R3 How your child(ren) are doing in life 1 2 3 4 5

SECTION 4S

ADMINISTRATOR ASK OF EVERYONE

In this next section you will be asked about your experiences in your broader community as well as your relationships with relatives and friends

Over the last 3 months have you regularly done the following

No Yes

S1 Participated in a religious or spiritual community

0 1

S2 Volunteered for a charity political group or other local organization (for example a service organization a political campaign)

0 1

S3 Participated in a community group that shares similar hobbies (for example a sports team a book club)

0 1

S4 Participated in a community group with shared background characteristics (for example a Veterans organization momrsquos group)

0 1

Well-Being Inventory (05 August 2019) National Center for PTSD Page 20 of 23

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
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      229. Explain living situation
      230. Annual salary
      231. Hourly
      232. estimate
      233. readily available
      234. expenses
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      479. P2-2 Off
      480. Children1
      481. Children2
      482. Children3
      483. Children4
      484. Children5
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      487. Q1-1 Off
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      606. Text Field 1
Page 2: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Note to Test Administrators

Please note that this document includes WBI items along with suggested instructions to include with WBI item sets Guidance for test administrators is provided throughout the document and should not be included when administering WBI measures to respondents As indicated in the manual that accompanies this measurement tool separate item sets may be extracted from the full inventory and administered separately WBI measures may be administered via paper-and-pencil web or telephone If the full inventory is administered via paper-and-pencil it is important to explain to test-takers that some sections may not be relevant for them and that they can skip these sections (for example individuals who are not parents should not be asked to complete parental functioning items) In addition items that are denoted as contextual items are not part of the WBI scoring and do not need to be administered to generate WBI measure scores Further details on the WBI and its scoring are available in the WBI manual

Participant ID

Well-Being Inventory Instructions This inventory contains questions regarding your experiences in the key life domains of vocation (work education) finances health and social relationships Please follow the instructions that are provided at the beginning of each section and select the most appropriate response Please be open and honest in your responses There are no right or wrong answers

SECTION 1 VOCATION (WORK AND EDUCATION)

SECTION 1A

In this section you will be asked about your work experiences

A1 What is your current employment status Working for pay Not working for pay but actively looking for paid work Not working for pay and not looking for paid work

ADMINISTRATOR ASK OF ALL THOSE WHO INDICATED THEY WORK FOR PAY

A2 In a typical week how many hours do you work for pay

A3 Do you have more than one paid job Yes No

A4 Which best describes your primary employer For-Profit Business (either public or private) Non-Proft Organization including tax exempt and charitable organizations State or Local Government organization such as public school fire department police department or other public service Federal Government organization such as Department of Veterans Affairs You are self-employed running your own business Other (please specify)

A5 Which best describes your primary field of work Agriculturefarming fishing forestry mining oilgas extraction Construction Facilities amp operations management (for example building and grounds keeping landscaping installation repairs maintenance operations and cleaning) Manufacturing of products (for example food beverages carpet fabric textile apparel tobacco paper toys motor vehicles)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 1 of 23

Participant ID

Transportation amp warehouse (for example aviation specialists including pilots and controllers postal service and delivery logistics couriers driver moving materials factory worker packing and distribution) Government public administration amp military (for example military or combat personnel national security or international afairs consultants or contractors and other government and support personnel) Police fire or other protective services (for example safety officer security correctional officer) Retail sales amp customer care (for example cashier customer service car sales real estate including rentalleasingselling broker landlord or other sales-related work) Hospitality service amp food management (for example housekeeping cook food preparation and service bartender server) Administration (for example human resources project management stafngemployment services and other ofce and administrative support personnel) Personal care (for example hairdresser cosmetologist barber ftness trainer and other personal services) Education amp other training-related work (for example teacher professor librarian academic advisor professional coach and other educational support services) Community amp social services (for example individual and family service provider child day care provider religious services including pastor clergy priest and other church ministry personnel) Arts entertainment media amp recreation (for example performing arts art galleries sports centers amusement and gambling industries) Computer information technology amp other technical services (for example newspaper or software publisher telecommunications data processing broadcasting computer design advertising) Healthcare practitioner therapist or support staff ( for example physician dentist chiropractor counselor nurse EMT residential care specialist) Architecture engineering amp science professionals Legal services (for example lawyer clerk or other legal work) Business amp financial operations (for example banking accounting auditing compliance officers claims processor quality assurance management financial and insurance services) Other (Please specify)

A6 Which best describes your position within your feld If you are not sure please make your best guess

Entry-level Mid-level Upper-level

A7 How long have you been in your current job (If you have more than one job please respond to this question with respect to your primary job)

years months

Well-Being Inventory (05 August 2019) National Center for PTSD Page 2 of 23

Participant ID

ADMINISTRATOR ASK OF EVERYONE

A8 Do you do any of the following types of unpaid work Mark all that apply I do not do any unpaid work Full-time care of children under the age of 18 Full-time care of an adult (for example spouseparentdisabled child over 18) Full-time homemaker without full-time child or elder care responsibilities Volunteer work (excluding time spent helping friends relatives andor neighbors)

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT WORKING FOR PAY BUT ACTIVELY LOOKING FOR PAID WORK IN A1

A9 What is the main reason you have not been working for pay Laid off Fired Quit my previous job Was unable to work due to medical problems Was in school or other training program Other reason (please specify)

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT WORKING FOR PAY AND NOT LOOKING FOR PAID WORK IN A1

A10 What is the main reason you are not looking for paid work Unable to work because of an injury or illness Unable to work because of an ongoing physical health condition or disability Unable to work because of an ongoing mentalemotional condition or disability Unable to find work Retired from the workforce Full-time homemaker andor caregiver In schooltraining Not interested in paid employment Other reason (please specify)

ADMINISTRATOR ASK OF ALL THOSE WHO INDICATED THAT THEY VOLUNTEER IN A8

A11 In a typical week how many hours of unpaid volunteer work do you do

A12 What type(s) of organization(s) do you volunteer for Mark all that apply Civic political professional or international Educational school or youth service Environmental or animal care Hospital or other health organization Public safety emergency services Religious

Well-Being Inventory (05 August 2019) National Center for PTSD Page 3 of 23

Participant ID

Social or community service Sport hobby cultural arts Veteran service organization Other (please specify)

A13 What type(s) of volunteer work do you do Mark all that apply Coach referee or supervise sports teams Tutor or teach Mentor youth or peers Usher greeter or minister Collect prepare distribute or serve food Fundraise or sell items to raise money Provide counseling medical care fire or protective services Provide general office services Provide professional or management assistance including serving on a board or committee Engage in music performance or other artistic activities Engage in general labor andor supply transportation to people Other (please specify)

SECTION 1B

ADMINISTRATOR ASK OF THOSE WHO INDICATE WORKING FOR PAY VOLUNTEERING OR CAREGIVING HOMEMAKING IN A1ampA8

Please answer the next questions with respect to the PRIMARY WORK you have done over the last 3 months For fulltime homemakers andor unpaid caregivers meal preparation household maintenance andor child-rearing may be considered your work For volunteers without paid employment volunteer work is considered your work

Over the last 3 months please indicate how often

Never Rarely Sometimes Often Most

or all of the time

B1 You completed your work when expected (for example attending work regularly completing tasks on time)

1 2 3 4 5

B2 You went above and beyond in your work (for example completing required tasks ahead of schedule taking on extra responsibilities)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 4 of 23

Participant ID

Over the last 3 months please indicate how often

Never Rarely Sometimes Often Most

or all of the time

B3 You maintained positive relationships with others in your work setting (for example avoiding confict when possible being patient with coworkers)

1 2 3 4 5

B4 The quality of your work was excellent

1 2 3 4 5

SECTION 1C

ADMINISTRATOR ASK OF THOSE WHO INDICATE WORKING FOR PAY IN A1

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

C1 Your pay and benefits 1 2 3 4 5

C2 Your work environment (for example people you work with work setting)

1 2 3 4 5

ADMINISTRATOR ASK OF THOSE WHO INDICATE WORKING FOR PAY VOLUNTEERING OR CAREGIVINGHOMEMAKING IN A1ampA8

Please answer the next questions with respect to the PRIMARY WORK you have done over the last 3 months For fulltime homemakers andor unpaid caregivers please note that meal preparation household maintenance andor child-rearing are considered your work For volunteers volunteer work is considered your work

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

C3 The kind of work you do 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 5 of 23

Participant ID

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

C4 How much your work contributions are valued

1 2 3 4 5

C5 Your ability to advance your vocational goals in your current role

1 2 3 4 5

C6 Your ability to apply your skills and knowledge to your work

1 2 3 4 5

SECTION 1D

In this next section you will be asked about your educational and training experiences

D1 Are you currently pursuing additional education or attending a trade or technicalvocational school (excluding on-the-job training)

Yes full-time (12 or more credits of coursework if in university setting) Yes part-time (less than 12 credits of coursework if in university setting) No

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

D2 What type of additional education or training are you pursuing High school diploma GED Technicalvocational training (for example carpentry computer programming medical technician training) Taking undergraduate courses but not enrolled in an undergraduate program Associatersquos degree (for example AA AS) Bachelorrsquos degree (for example BA BS) Taking graduate courses but not enrolled in a graduate program Masterrsquos degree (for example MA MS MEng MEd MSW MBA) Doctorate degree (for example PhD EdD) Professional degree beyond a bachelorrsquos degree (for example MD DDS DVM LLB JD)

D3 Which of the following best describes your primary feld of study in y our current education or training

Arts and humanities (for example English art history journalism) Biological sciences (for example biology environmental science) Business (for example accounting fnance)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 6 of 23

Participant ID

Education (for example elementary education special education) Computer-related (for example computer science information technology) Engineering (for example chemical or mechanical engineering) Physical science (for example chemistry statistics) Health science (for example nursing veterinary health technology) Social science (for example social work psychology) Technicalvocational training (please specify) Other (please specify)

ADMINISTRATOR ASK OF EVERYONE

D4 What is the highest degree or level of education you have completed Less than high school Some high school but no diploma or GED High school diploma GED Post-high school vocational or technical training Some college credit no degree Associatersquos degree (for example AA AS) Bachelorrsquos degree (for example BA BS) Masterrsquos degree (for example MA MS MEng MEd MSW MBA) Doctorate degree (for example PhD EdD) Professional degree beyond a bachelorrsquos degree (for example MD DDS DVM LLB JD)

SECTION 1E

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

Over the last 3 months of your education or training please indicate how often

Never Rarely Sometimes Often Most

or all of the time

E1 You completed all required courseworktraining activities

1 2 3 4 5

E2 You went above and beyond in your educational activities (for example completing assignments ahead of schedule participating in educational activities outside of class)

1 2 3 4 5

E3 You did your part to create a positive learning environment (for example contributing to discussions showing appreciation for othersrsquo viewpoints)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 7 of 23

Participant ID

Over the last 3 months of your education or training please indicate how often

Never Rarely Sometimes Often Most

or all of the time

E4 The quality of your coursework training activities was excellent

1 2 3 4 5

SECTION 1F

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

Over the last 3 months of your education or training how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

F1 The quality of your education or training experience

1 2 3 4 5

F2 The extent to which your education or training is advancing your career goals

1 2 3 4 5

F3 Your learning environment (for example teachers and other students educational setting)

1 2 3 4 5

SECTION 2 FINANCES

In the next section we ask about your fnancial cir cumstances Please remember that all information you provide is completely confden tial and will be used to better understand your fnancial w ell-being Also if you are not sure how to answer some of these questions please provide your best guess

In this set of questions your household refers to you other earners who share the majority of expenses and those who depend on this income (for example children or elders)

SECTION 2G

ADMINISTRATOR ASK OF EVERYONE

G1 Are you able to pay for all necessary expenses each month such as mortgagerent debt payments and groceries

Well-Being Inventory (05 August 2019) National Center for PTSD Page 8 of 23

Participant ID

Yes No

G2 Does your household have at least 3 months of your typical income set aside in case of an unexpected fnancial ev ent

Yes No

G3 Does your household have the insurance coverage you andor your family would need if an unexpected financial event were to occur (for example disability insurance property insurance and or life insurance)

Yes No

G4 Has your household begun to set aside money for retirement Yes No

G5 Is your household more than one month behind on your debt payments (for example mortgage or credit card)

No my household is not more than one month behind in debt payments Yes my household is over one month behind in debt payments Not applicable - my household does not have any debt

G6 Are you currently concerned that you will lose your housing and be unable to find stable alternative housing

Yes No

ADMINISTRATOR ASK OF EVERYONE

G7

G8

How many people are supported by your HOUSEHOLD income including yourself your significant other (if you have one) and anyone else partially or fully supported by this income whether or not they live with you

What is your current living situation Rent an apartment house or room Own an apartment or house Live with a friend or relative and not paying rent Live in a dormitory at school Live in a medical or assisted living facility such as a hospital or rehab center Live in transitional housing (for example a halfway house) Live in a car on the street or in a homeless shelter

Well-Being Inventory (05 August 2019) National Center for PTSD Page 9 of 23

Participant ID

Somewhere else (fll-in

ADMINISTRATOR ASK OF THOSE WHO INDICATED THEY WORK FOR PAY IN A1

G9 Please provide your expected annual SALARY before taxes are taken out If you do not know your salary please indicate how much you expect to earn per hour (before taxes) If you do not know the answer please make your best guess

ANNUAL SALARY (before taxes)

-OR-

HOURLY PAY RATE (before taxes)

ADMINISTRATOR ASK OF EVERYONE

G10 Please provide an estimate of your HOUSEHOLDrsquoS yearly income before taxes are taken out Include all sources of income including salary as well as any disability payments real estate income and any other sources of income from all earners in your household If you do not have other sources of income and you are the only earner in your household this may be the same as your salary If you do not know the answer please make your best guess

$

ADMINISTRATOR ASK OF EVERYONE

G11 Approximately how much money does your household have readily available (for example in cash and savings) to cover a financial emergency such as loss of a job If you do not know the answer make your best guess

$

G12 Approximately how much does your HOUSEHOLD pay towards debt and housing expenses PER MONTH (for example mortgagerent bills credit card debt student loans etc)

$

ADMINISTRATOR ASK OF EVERYONE

SECTION 2H

Well-Being Inventory (05 August 2019) National Center for PTSD Page 10 of 22

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most or all of the time

H1 Followed a budget 1 2 3 4 5

H2 Compared prices when purchasing a product or service

1 2 3 4 5

H3 Kept a written or electronic record of your spending

1 2 3 4 5

H4 Been late in paying a bill 1 2 3 4 5

H5 Had credit card debt that you did not pay of each mon th

1 2 3 4 5

H6 Spent more than you could afford on clothing entertainment and other extras

1 2 3 4 5

H7 Contributed part of each paycheck (or other income) to a retirement account such as a 401k or IRA

1 2 3 4 5

H8 Contributed part of each paycheck (or other income) to a personal savings account

1 2 3 4 5

SECTION 2I

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I1 Your ability to pay for necessities 1 2 3 4 5

I2 Your ability to afford extras (for example vacation dinner out)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 11 of 22

Participant ID

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I3 The amount of savings you have 1 2 3 4 5

I4 The amount of debt you have 1 2 3 4 5

SECTION 3 CURRENT HEALTH

In this next section you will be asked about your current physical and emotionalmental health

SECTION 3J

ADMINISTRATOR ASK OF EVERYONE

J1 Do you have an ongoing physical health condition illness or disability (for example high blood pressure pain)

Yes No

J2 Do you have an ongoing mentalemotional health condition illness or disability (for example depression anxiety)

Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE A PHYSICAL HEALTH PROBLEM IN J1 OR A MENTAL HEALTH PROBLEM IN J2

J3 What ongoing physical or mentalemotional health conditions illnesses or disabilities do you have Mark all that apply

High blood pressure or other heart problem High cholesterol Diabetes requiring insulin other medication or special diet Obesity Sleep problem or disorder Chronic pain or pain related disorder (for example knee back migraines)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 12 of 23

Participant ID

Arthritis A hearing condition that is not correctable Alcohol or drug (including prescription drugs) abusedependence Posttraumatic stress disorder Depression Anxiety disorder (for example panic disorder generalized anxiety disorder)Other chronic physical or mental health problem 1 (please specify) Other chronic physical or mental health problem 2 (please specify) Other chronic physical or mental health problem 3 (please specify)

ADMINISTRATOR ASK OF EVERYONE

J4 Do you have healthcare coverage (for example employer-provided health insurance Medicaid) Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATED THAT THEY HAVE HEALTHCARE COVERAGE IN J4

J5 Which of the following best describe your main sources of healthcare coverage Employer-provided health insurance (could be from your current or former employer a family memberrsquos current or former employer or a union) A plan you purchased through a healthcare exchange (for example Healthcaregov State exchange Obamacare etc) TRICARE VA Medicaid Medicare Other government assisted health plan Something else (please specify)

SECTION 3K

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K1 Eaten a generally healthy diet (for example low fat limited sugar adequate servings of fruits and vegetables)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 13 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K2 Gotten at least 2 hours and 30 minutes of moderate physical activity OR 1 hour and 15 minutes of vigorous activity each week

1 2 3 4 5

K3 Done muscle strengthening exercises at least two days per week

1 2 3 4 5

K4 Gotten quality sleep 1 2 3 4 5

K5 Had sexual intercourse without a condom with more than one person or with a person you did not know

1 2 3 4 5

K6 Used tobacco andor nicotine products (for example cigarettes cigars vape)

1 2 3 4 5

K7 Used alcohol in a way that put your health at risk (for example blacking out driving drunk)

1 2 3 4 5

K8 Used drugs (including prescription drugs) in a way that put your health at risk (for example losing memory or consciousness driving under the infuence)

1 2 3 4 5

K9 Completed recommended medical care (for example physical exams)

1 2 3 4 5

K10 Maintained personal cleanliness (for example personal care household chores)

1 2 3 4 5

K11 Spent time doing things that you enjoy

1 2 3 4 5

K12 Spent time doing things that you find personally meaningful

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 14 of 23

Participant ID

SECTION 3L

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

L1 Your physical health 1 2 3 4 5

L2 Your emotionalmental health 1 2 3 4 5

L3 Your health care 1 2 3 4 5

SECTION 4 SOCIAL RELATIONSHIPS

In this next section you will be asked about your romantic relationship involvement

SECTION 4M

ADMINISTRATOR ASK OF EVERYONE

M1 What is your current marital status

Never married Married - first and only marriage Married - second or later marriage Separated Divorced Widowed

ADMINISTRATOR ASK OF THOSE WHO DID NOT INDICATE MARRIED IN M1

M2 Are you currently in a romantic relationship Currently in a relationship and living as a couple Currently in a relationship but not living as a couple Not currently in a relationship

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 15 of 23

Participant ID

M3 How long have you been married or in your current relationship years months

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT MARRIED ON M1 AND NOT IN A RELATIONSHIP ON M2

M4 Which of the following is true with respect to your romantic relationship status I would like to be in a relationship I prefer not to be in a relationship at this time

SECTION 4N

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Over the last 3 months how often have you done the following in your romantic relationship

Never Rarely Sometimes Often Most

or all of the time

N1 Provided your significant other with the emotional support they sought

1 2 3 4 5

N2 Shared your intimate thoughts and feelings

1 2 3 4 5

N3 Done your fair share of day-to-day tasks (for example grocery shopping errands planning activities)

1 2 3 4 5

N4 Initiated leisure time activities that both you and your signifcan t other enjoy

1 2 3 4 5

N5 Made ef ort to work through disagreements respectfully

1 2 3 4 5

N6 Expressed interest andor willingness to engage in regular sexual or physical intimacy

1 2 3 4 5

SECTION 4O

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 16 of 23

Participant ID

Everybody has aspects of their relationship that make them more or less happy Over the last 3 months how satisfied have you been with your significant otherrsquos contribution to the following aspects of your romantic relationship

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

O1Emotional closeness (for example sharing personal thoughts and feelings)

1 2 3 4 5

O2Companionship (for example doing enjoyable activities together)

1 2 3 4 5

O3Sexual and physical intimacy (for example holding hands or having sex)

1 2 3 4 5

O4 Intellectual connection (for example having many things to talk about)

1 2 3 4 5

O5Security (for example being able to trust and depend on partner)

1 2 3 4 5

O6Division of day-to-day tasks (for example your partnerrsquos contribution to chores and planning activities)

1 2 3 4 5

In this next section you will be asked about your parenting experiences

SECTION 4P

P1 Are you a parent or have you served in a parenting role during the past three months Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P2 Do you have children who are age 18 or younger Yes No

Well-Being Inventory (05 August 2019) National Center for PTSD Page 17 of 23

Participant ID

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P3 How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities) Enter a number on each line write 0 if you do not have any children in that age category

Number of Children

Under 5 years old

Age 5 through 12 years old

Age 13 through 18 years old

Age 19 through 26

27 years +

ADMINISTRATOR ASK OF THOSE WHO DO NOT INDICATE HAVING CHILDREN IN P1

P4 Which of the following is true with respect to your parenting status I would like to be a parent now I prefer not to be a parent at this time

SECTION 4Q

ADMINISTRATOR ASK OF ALL THOSE WHO HAVE CHILDREN UNDER 18 IN P2

Please answer the following questions with regard to children 18 or under for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 18 of 23

Participant ID

All parents have strengths and weaknesses Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

Q1Provided a healthy environment for your child(ren) (for example preparing healthy meals caring for their health keeping them safe)

1 2 3 4 5

Q2Been a good example for your child(ren) (for example being respectful during disagreements with others taking good care of your own health)

1 2 3 4 5

Q3Been actively involved in your child(ren)rsquos activities (for example regularly attending sporting and school events giving your full attention during time together)

1 2 3 4 5

Q4Met your child(ren)rsquos needs for physical affection and emotional support (for example giving them hugs being sympathetic to their problems)

1 2 3 4 5

Q5Been able to successfully manage your child(ren)rsquos unique challenges (for example efectively disciplining children)

1 2 3 4 5

SECTION 4R

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

Please answer the following questions with regard to ALL children for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 19 of 23

Participant ID

Parenting can be both rewarding and challenging How satisfed have you been with the following aspects of your parenting experiences over the last 3 months

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

R1 How close you are with your child(ren)

1 2 3 4 5

R2 How much enjoyment you get from parenting

1 2 3 4 5

R3 How your child(ren) are doing in life 1 2 3 4 5

SECTION 4S

ADMINISTRATOR ASK OF EVERYONE

In this next section you will be asked about your experiences in your broader community as well as your relationships with relatives and friends

Over the last 3 months have you regularly done the following

No Yes

S1 Participated in a religious or spiritual community

0 1

S2 Volunteered for a charity political group or other local organization (for example a service organization a political campaign)

0 1

S3 Participated in a community group that shares similar hobbies (for example a sports team a book club)

0 1

S4 Participated in a community group with shared background characteristics (for example a Veterans organization momrsquos group)

0 1

Well-Being Inventory (05 August 2019) National Center for PTSD Page 20 of 23

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
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      230. Annual salary
      231. Hourly
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      234. expenses
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      606. Text Field 1
Page 3: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Participant ID

Well-Being Inventory Instructions This inventory contains questions regarding your experiences in the key life domains of vocation (work education) finances health and social relationships Please follow the instructions that are provided at the beginning of each section and select the most appropriate response Please be open and honest in your responses There are no right or wrong answers

SECTION 1 VOCATION (WORK AND EDUCATION)

SECTION 1A

In this section you will be asked about your work experiences

A1 What is your current employment status Working for pay Not working for pay but actively looking for paid work Not working for pay and not looking for paid work

ADMINISTRATOR ASK OF ALL THOSE WHO INDICATED THEY WORK FOR PAY

A2 In a typical week how many hours do you work for pay

A3 Do you have more than one paid job Yes No

A4 Which best describes your primary employer For-Profit Business (either public or private) Non-Proft Organization including tax exempt and charitable organizations State or Local Government organization such as public school fire department police department or other public service Federal Government organization such as Department of Veterans Affairs You are self-employed running your own business Other (please specify)

A5 Which best describes your primary field of work Agriculturefarming fishing forestry mining oilgas extraction Construction Facilities amp operations management (for example building and grounds keeping landscaping installation repairs maintenance operations and cleaning) Manufacturing of products (for example food beverages carpet fabric textile apparel tobacco paper toys motor vehicles)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 1 of 23

Participant ID

Transportation amp warehouse (for example aviation specialists including pilots and controllers postal service and delivery logistics couriers driver moving materials factory worker packing and distribution) Government public administration amp military (for example military or combat personnel national security or international afairs consultants or contractors and other government and support personnel) Police fire or other protective services (for example safety officer security correctional officer) Retail sales amp customer care (for example cashier customer service car sales real estate including rentalleasingselling broker landlord or other sales-related work) Hospitality service amp food management (for example housekeeping cook food preparation and service bartender server) Administration (for example human resources project management stafngemployment services and other ofce and administrative support personnel) Personal care (for example hairdresser cosmetologist barber ftness trainer and other personal services) Education amp other training-related work (for example teacher professor librarian academic advisor professional coach and other educational support services) Community amp social services (for example individual and family service provider child day care provider religious services including pastor clergy priest and other church ministry personnel) Arts entertainment media amp recreation (for example performing arts art galleries sports centers amusement and gambling industries) Computer information technology amp other technical services (for example newspaper or software publisher telecommunications data processing broadcasting computer design advertising) Healthcare practitioner therapist or support staff ( for example physician dentist chiropractor counselor nurse EMT residential care specialist) Architecture engineering amp science professionals Legal services (for example lawyer clerk or other legal work) Business amp financial operations (for example banking accounting auditing compliance officers claims processor quality assurance management financial and insurance services) Other (Please specify)

A6 Which best describes your position within your feld If you are not sure please make your best guess

Entry-level Mid-level Upper-level

A7 How long have you been in your current job (If you have more than one job please respond to this question with respect to your primary job)

years months

Well-Being Inventory (05 August 2019) National Center for PTSD Page 2 of 23

Participant ID

ADMINISTRATOR ASK OF EVERYONE

A8 Do you do any of the following types of unpaid work Mark all that apply I do not do any unpaid work Full-time care of children under the age of 18 Full-time care of an adult (for example spouseparentdisabled child over 18) Full-time homemaker without full-time child or elder care responsibilities Volunteer work (excluding time spent helping friends relatives andor neighbors)

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT WORKING FOR PAY BUT ACTIVELY LOOKING FOR PAID WORK IN A1

A9 What is the main reason you have not been working for pay Laid off Fired Quit my previous job Was unable to work due to medical problems Was in school or other training program Other reason (please specify)

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT WORKING FOR PAY AND NOT LOOKING FOR PAID WORK IN A1

A10 What is the main reason you are not looking for paid work Unable to work because of an injury or illness Unable to work because of an ongoing physical health condition or disability Unable to work because of an ongoing mentalemotional condition or disability Unable to find work Retired from the workforce Full-time homemaker andor caregiver In schooltraining Not interested in paid employment Other reason (please specify)

ADMINISTRATOR ASK OF ALL THOSE WHO INDICATED THAT THEY VOLUNTEER IN A8

A11 In a typical week how many hours of unpaid volunteer work do you do

A12 What type(s) of organization(s) do you volunteer for Mark all that apply Civic political professional or international Educational school or youth service Environmental or animal care Hospital or other health organization Public safety emergency services Religious

Well-Being Inventory (05 August 2019) National Center for PTSD Page 3 of 23

Participant ID

Social or community service Sport hobby cultural arts Veteran service organization Other (please specify)

A13 What type(s) of volunteer work do you do Mark all that apply Coach referee or supervise sports teams Tutor or teach Mentor youth or peers Usher greeter or minister Collect prepare distribute or serve food Fundraise or sell items to raise money Provide counseling medical care fire or protective services Provide general office services Provide professional or management assistance including serving on a board or committee Engage in music performance or other artistic activities Engage in general labor andor supply transportation to people Other (please specify)

SECTION 1B

ADMINISTRATOR ASK OF THOSE WHO INDICATE WORKING FOR PAY VOLUNTEERING OR CAREGIVING HOMEMAKING IN A1ampA8

Please answer the next questions with respect to the PRIMARY WORK you have done over the last 3 months For fulltime homemakers andor unpaid caregivers meal preparation household maintenance andor child-rearing may be considered your work For volunteers without paid employment volunteer work is considered your work

Over the last 3 months please indicate how often

Never Rarely Sometimes Often Most

or all of the time

B1 You completed your work when expected (for example attending work regularly completing tasks on time)

1 2 3 4 5

B2 You went above and beyond in your work (for example completing required tasks ahead of schedule taking on extra responsibilities)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 4 of 23

Participant ID

Over the last 3 months please indicate how often

Never Rarely Sometimes Often Most

or all of the time

B3 You maintained positive relationships with others in your work setting (for example avoiding confict when possible being patient with coworkers)

1 2 3 4 5

B4 The quality of your work was excellent

1 2 3 4 5

SECTION 1C

ADMINISTRATOR ASK OF THOSE WHO INDICATE WORKING FOR PAY IN A1

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

C1 Your pay and benefits 1 2 3 4 5

C2 Your work environment (for example people you work with work setting)

1 2 3 4 5

ADMINISTRATOR ASK OF THOSE WHO INDICATE WORKING FOR PAY VOLUNTEERING OR CAREGIVINGHOMEMAKING IN A1ampA8

Please answer the next questions with respect to the PRIMARY WORK you have done over the last 3 months For fulltime homemakers andor unpaid caregivers please note that meal preparation household maintenance andor child-rearing are considered your work For volunteers volunteer work is considered your work

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

C3 The kind of work you do 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 5 of 23

Participant ID

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

C4 How much your work contributions are valued

1 2 3 4 5

C5 Your ability to advance your vocational goals in your current role

1 2 3 4 5

C6 Your ability to apply your skills and knowledge to your work

1 2 3 4 5

SECTION 1D

In this next section you will be asked about your educational and training experiences

D1 Are you currently pursuing additional education or attending a trade or technicalvocational school (excluding on-the-job training)

Yes full-time (12 or more credits of coursework if in university setting) Yes part-time (less than 12 credits of coursework if in university setting) No

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

D2 What type of additional education or training are you pursuing High school diploma GED Technicalvocational training (for example carpentry computer programming medical technician training) Taking undergraduate courses but not enrolled in an undergraduate program Associatersquos degree (for example AA AS) Bachelorrsquos degree (for example BA BS) Taking graduate courses but not enrolled in a graduate program Masterrsquos degree (for example MA MS MEng MEd MSW MBA) Doctorate degree (for example PhD EdD) Professional degree beyond a bachelorrsquos degree (for example MD DDS DVM LLB JD)

D3 Which of the following best describes your primary feld of study in y our current education or training

Arts and humanities (for example English art history journalism) Biological sciences (for example biology environmental science) Business (for example accounting fnance)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 6 of 23

Participant ID

Education (for example elementary education special education) Computer-related (for example computer science information technology) Engineering (for example chemical or mechanical engineering) Physical science (for example chemistry statistics) Health science (for example nursing veterinary health technology) Social science (for example social work psychology) Technicalvocational training (please specify) Other (please specify)

ADMINISTRATOR ASK OF EVERYONE

D4 What is the highest degree or level of education you have completed Less than high school Some high school but no diploma or GED High school diploma GED Post-high school vocational or technical training Some college credit no degree Associatersquos degree (for example AA AS) Bachelorrsquos degree (for example BA BS) Masterrsquos degree (for example MA MS MEng MEd MSW MBA) Doctorate degree (for example PhD EdD) Professional degree beyond a bachelorrsquos degree (for example MD DDS DVM LLB JD)

SECTION 1E

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

Over the last 3 months of your education or training please indicate how often

Never Rarely Sometimes Often Most

or all of the time

E1 You completed all required courseworktraining activities

1 2 3 4 5

E2 You went above and beyond in your educational activities (for example completing assignments ahead of schedule participating in educational activities outside of class)

1 2 3 4 5

E3 You did your part to create a positive learning environment (for example contributing to discussions showing appreciation for othersrsquo viewpoints)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 7 of 23

Participant ID

Over the last 3 months of your education or training please indicate how often

Never Rarely Sometimes Often Most

or all of the time

E4 The quality of your coursework training activities was excellent

1 2 3 4 5

SECTION 1F

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

Over the last 3 months of your education or training how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

F1 The quality of your education or training experience

1 2 3 4 5

F2 The extent to which your education or training is advancing your career goals

1 2 3 4 5

F3 Your learning environment (for example teachers and other students educational setting)

1 2 3 4 5

SECTION 2 FINANCES

In the next section we ask about your fnancial cir cumstances Please remember that all information you provide is completely confden tial and will be used to better understand your fnancial w ell-being Also if you are not sure how to answer some of these questions please provide your best guess

In this set of questions your household refers to you other earners who share the majority of expenses and those who depend on this income (for example children or elders)

SECTION 2G

ADMINISTRATOR ASK OF EVERYONE

G1 Are you able to pay for all necessary expenses each month such as mortgagerent debt payments and groceries

Well-Being Inventory (05 August 2019) National Center for PTSD Page 8 of 23

Participant ID

Yes No

G2 Does your household have at least 3 months of your typical income set aside in case of an unexpected fnancial ev ent

Yes No

G3 Does your household have the insurance coverage you andor your family would need if an unexpected financial event were to occur (for example disability insurance property insurance and or life insurance)

Yes No

G4 Has your household begun to set aside money for retirement Yes No

G5 Is your household more than one month behind on your debt payments (for example mortgage or credit card)

No my household is not more than one month behind in debt payments Yes my household is over one month behind in debt payments Not applicable - my household does not have any debt

G6 Are you currently concerned that you will lose your housing and be unable to find stable alternative housing

Yes No

ADMINISTRATOR ASK OF EVERYONE

G7

G8

How many people are supported by your HOUSEHOLD income including yourself your significant other (if you have one) and anyone else partially or fully supported by this income whether or not they live with you

What is your current living situation Rent an apartment house or room Own an apartment or house Live with a friend or relative and not paying rent Live in a dormitory at school Live in a medical or assisted living facility such as a hospital or rehab center Live in transitional housing (for example a halfway house) Live in a car on the street or in a homeless shelter

Well-Being Inventory (05 August 2019) National Center for PTSD Page 9 of 23

Participant ID

Somewhere else (fll-in

ADMINISTRATOR ASK OF THOSE WHO INDICATED THEY WORK FOR PAY IN A1

G9 Please provide your expected annual SALARY before taxes are taken out If you do not know your salary please indicate how much you expect to earn per hour (before taxes) If you do not know the answer please make your best guess

ANNUAL SALARY (before taxes)

-OR-

HOURLY PAY RATE (before taxes)

ADMINISTRATOR ASK OF EVERYONE

G10 Please provide an estimate of your HOUSEHOLDrsquoS yearly income before taxes are taken out Include all sources of income including salary as well as any disability payments real estate income and any other sources of income from all earners in your household If you do not have other sources of income and you are the only earner in your household this may be the same as your salary If you do not know the answer please make your best guess

$

ADMINISTRATOR ASK OF EVERYONE

G11 Approximately how much money does your household have readily available (for example in cash and savings) to cover a financial emergency such as loss of a job If you do not know the answer make your best guess

$

G12 Approximately how much does your HOUSEHOLD pay towards debt and housing expenses PER MONTH (for example mortgagerent bills credit card debt student loans etc)

$

ADMINISTRATOR ASK OF EVERYONE

SECTION 2H

Well-Being Inventory (05 August 2019) National Center for PTSD Page 10 of 22

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most or all of the time

H1 Followed a budget 1 2 3 4 5

H2 Compared prices when purchasing a product or service

1 2 3 4 5

H3 Kept a written or electronic record of your spending

1 2 3 4 5

H4 Been late in paying a bill 1 2 3 4 5

H5 Had credit card debt that you did not pay of each mon th

1 2 3 4 5

H6 Spent more than you could afford on clothing entertainment and other extras

1 2 3 4 5

H7 Contributed part of each paycheck (or other income) to a retirement account such as a 401k or IRA

1 2 3 4 5

H8 Contributed part of each paycheck (or other income) to a personal savings account

1 2 3 4 5

SECTION 2I

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I1 Your ability to pay for necessities 1 2 3 4 5

I2 Your ability to afford extras (for example vacation dinner out)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 11 of 22

Participant ID

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I3 The amount of savings you have 1 2 3 4 5

I4 The amount of debt you have 1 2 3 4 5

SECTION 3 CURRENT HEALTH

In this next section you will be asked about your current physical and emotionalmental health

SECTION 3J

ADMINISTRATOR ASK OF EVERYONE

J1 Do you have an ongoing physical health condition illness or disability (for example high blood pressure pain)

Yes No

J2 Do you have an ongoing mentalemotional health condition illness or disability (for example depression anxiety)

Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE A PHYSICAL HEALTH PROBLEM IN J1 OR A MENTAL HEALTH PROBLEM IN J2

J3 What ongoing physical or mentalemotional health conditions illnesses or disabilities do you have Mark all that apply

High blood pressure or other heart problem High cholesterol Diabetes requiring insulin other medication or special diet Obesity Sleep problem or disorder Chronic pain or pain related disorder (for example knee back migraines)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 12 of 23

Participant ID

Arthritis A hearing condition that is not correctable Alcohol or drug (including prescription drugs) abusedependence Posttraumatic stress disorder Depression Anxiety disorder (for example panic disorder generalized anxiety disorder)Other chronic physical or mental health problem 1 (please specify) Other chronic physical or mental health problem 2 (please specify) Other chronic physical or mental health problem 3 (please specify)

ADMINISTRATOR ASK OF EVERYONE

J4 Do you have healthcare coverage (for example employer-provided health insurance Medicaid) Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATED THAT THEY HAVE HEALTHCARE COVERAGE IN J4

J5 Which of the following best describe your main sources of healthcare coverage Employer-provided health insurance (could be from your current or former employer a family memberrsquos current or former employer or a union) A plan you purchased through a healthcare exchange (for example Healthcaregov State exchange Obamacare etc) TRICARE VA Medicaid Medicare Other government assisted health plan Something else (please specify)

SECTION 3K

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K1 Eaten a generally healthy diet (for example low fat limited sugar adequate servings of fruits and vegetables)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 13 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K2 Gotten at least 2 hours and 30 minutes of moderate physical activity OR 1 hour and 15 minutes of vigorous activity each week

1 2 3 4 5

K3 Done muscle strengthening exercises at least two days per week

1 2 3 4 5

K4 Gotten quality sleep 1 2 3 4 5

K5 Had sexual intercourse without a condom with more than one person or with a person you did not know

1 2 3 4 5

K6 Used tobacco andor nicotine products (for example cigarettes cigars vape)

1 2 3 4 5

K7 Used alcohol in a way that put your health at risk (for example blacking out driving drunk)

1 2 3 4 5

K8 Used drugs (including prescription drugs) in a way that put your health at risk (for example losing memory or consciousness driving under the infuence)

1 2 3 4 5

K9 Completed recommended medical care (for example physical exams)

1 2 3 4 5

K10 Maintained personal cleanliness (for example personal care household chores)

1 2 3 4 5

K11 Spent time doing things that you enjoy

1 2 3 4 5

K12 Spent time doing things that you find personally meaningful

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 14 of 23

Participant ID

SECTION 3L

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

L1 Your physical health 1 2 3 4 5

L2 Your emotionalmental health 1 2 3 4 5

L3 Your health care 1 2 3 4 5

SECTION 4 SOCIAL RELATIONSHIPS

In this next section you will be asked about your romantic relationship involvement

SECTION 4M

ADMINISTRATOR ASK OF EVERYONE

M1 What is your current marital status

Never married Married - first and only marriage Married - second or later marriage Separated Divorced Widowed

ADMINISTRATOR ASK OF THOSE WHO DID NOT INDICATE MARRIED IN M1

M2 Are you currently in a romantic relationship Currently in a relationship and living as a couple Currently in a relationship but not living as a couple Not currently in a relationship

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 15 of 23

Participant ID

M3 How long have you been married or in your current relationship years months

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT MARRIED ON M1 AND NOT IN A RELATIONSHIP ON M2

M4 Which of the following is true with respect to your romantic relationship status I would like to be in a relationship I prefer not to be in a relationship at this time

SECTION 4N

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Over the last 3 months how often have you done the following in your romantic relationship

Never Rarely Sometimes Often Most

or all of the time

N1 Provided your significant other with the emotional support they sought

1 2 3 4 5

N2 Shared your intimate thoughts and feelings

1 2 3 4 5

N3 Done your fair share of day-to-day tasks (for example grocery shopping errands planning activities)

1 2 3 4 5

N4 Initiated leisure time activities that both you and your signifcan t other enjoy

1 2 3 4 5

N5 Made ef ort to work through disagreements respectfully

1 2 3 4 5

N6 Expressed interest andor willingness to engage in regular sexual or physical intimacy

1 2 3 4 5

SECTION 4O

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 16 of 23

Participant ID

Everybody has aspects of their relationship that make them more or less happy Over the last 3 months how satisfied have you been with your significant otherrsquos contribution to the following aspects of your romantic relationship

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

O1Emotional closeness (for example sharing personal thoughts and feelings)

1 2 3 4 5

O2Companionship (for example doing enjoyable activities together)

1 2 3 4 5

O3Sexual and physical intimacy (for example holding hands or having sex)

1 2 3 4 5

O4 Intellectual connection (for example having many things to talk about)

1 2 3 4 5

O5Security (for example being able to trust and depend on partner)

1 2 3 4 5

O6Division of day-to-day tasks (for example your partnerrsquos contribution to chores and planning activities)

1 2 3 4 5

In this next section you will be asked about your parenting experiences

SECTION 4P

P1 Are you a parent or have you served in a parenting role during the past three months Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P2 Do you have children who are age 18 or younger Yes No

Well-Being Inventory (05 August 2019) National Center for PTSD Page 17 of 23

Participant ID

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P3 How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities) Enter a number on each line write 0 if you do not have any children in that age category

Number of Children

Under 5 years old

Age 5 through 12 years old

Age 13 through 18 years old

Age 19 through 26

27 years +

ADMINISTRATOR ASK OF THOSE WHO DO NOT INDICATE HAVING CHILDREN IN P1

P4 Which of the following is true with respect to your parenting status I would like to be a parent now I prefer not to be a parent at this time

SECTION 4Q

ADMINISTRATOR ASK OF ALL THOSE WHO HAVE CHILDREN UNDER 18 IN P2

Please answer the following questions with regard to children 18 or under for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 18 of 23

Participant ID

All parents have strengths and weaknesses Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

Q1Provided a healthy environment for your child(ren) (for example preparing healthy meals caring for their health keeping them safe)

1 2 3 4 5

Q2Been a good example for your child(ren) (for example being respectful during disagreements with others taking good care of your own health)

1 2 3 4 5

Q3Been actively involved in your child(ren)rsquos activities (for example regularly attending sporting and school events giving your full attention during time together)

1 2 3 4 5

Q4Met your child(ren)rsquos needs for physical affection and emotional support (for example giving them hugs being sympathetic to their problems)

1 2 3 4 5

Q5Been able to successfully manage your child(ren)rsquos unique challenges (for example efectively disciplining children)

1 2 3 4 5

SECTION 4R

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

Please answer the following questions with regard to ALL children for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 19 of 23

Participant ID

Parenting can be both rewarding and challenging How satisfed have you been with the following aspects of your parenting experiences over the last 3 months

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

R1 How close you are with your child(ren)

1 2 3 4 5

R2 How much enjoyment you get from parenting

1 2 3 4 5

R3 How your child(ren) are doing in life 1 2 3 4 5

SECTION 4S

ADMINISTRATOR ASK OF EVERYONE

In this next section you will be asked about your experiences in your broader community as well as your relationships with relatives and friends

Over the last 3 months have you regularly done the following

No Yes

S1 Participated in a religious or spiritual community

0 1

S2 Volunteered for a charity political group or other local organization (for example a service organization a political campaign)

0 1

S3 Participated in a community group that shares similar hobbies (for example a sports team a book club)

0 1

S4 Participated in a community group with shared background characteristics (for example a Veterans organization momrsquos group)

0 1

Well-Being Inventory (05 August 2019) National Center for PTSD Page 20 of 23

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
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      413. months2
      414. M4-1 Off
      415. M4-2 Off
      416. N1-1 Off
      417. N1-2 Off
      418. N1-3 Off
      419. N1-4 Off
      420. N1-5 Off
      421. N2-1 Off
      422. N2-2 Off
      423. N2-3 Off
      424. N2-4 Off
      425. N2-5 Off
      426. N3-1 Off
      427. N3-2 Off
      428. N3-3 Off
      429. N3-4 Off
      430. N3-5 Off
      431. N4-1 Off
      432. N4-2 Off
      433. N4-3 Off
      434. N4- Off
      435. N4-5 Off
      436. N5-1 Off
      437. N5-2 Off
      438. N5-3 Off
      439. N5- Off
      440. N5-5 Off
      441. N6-1 Off
      442. N6-2 Off
      443. N6-3 Off
      444. N6-4 Off
      445. N6-5 Off
      446. O1-1 Off
      447. O1-2 Off
      448. O1-3 Off
      449. O1-4 Off
      450. O1-5 Off
      451. O2-1 Off
      452. O2-2 Off
      453. O2-3 Off
      454. O2-4 Off
      455. O2-5 Off
      456. O3-1 Off
      457. O3-2 Off
      458. O3-3 Off
      459. O3-4 Off
      460. O3-5 Off
      461. O4-1 Off
      462. O4-2 Off
      463. O4-3 Off
      464. O4-4 Off
      465. O4-5 Off
      466. O5-1 Off
      467. O5-2 Off
      468. O5-3 Off
      469. O5-4 Off
      470. O5-5 Off
      471. O6-1 Off
      472. O6-2 Off
      473. O6-3 Off
      474. O6-4 Off
      475. O6-5 Off
      476. P1-1 Off
      477. P1-2 Off
      478. P2-1 Off
      479. P2-2 Off
      480. Children1
      481. Children2
      482. Children3
      483. Children4
      484. Children5
      485. P4-1 Off
      486. P4-2 Off
      487. Q1-1 Off
      488. Q1-2 Off
      489. Q1-3 Off
      490. Q1-4 Off
      491. Q1-5 Off
      492. Q2-1 Off
      493. Q2-2 Off
      494. Q2-3 Off
      495. Q2-4 Off
      496. Q2-5 Off
      497. Q3-1 Off
      498. Q3-2 Off
      499. Q3-3 Off
      500. Q3-4 Off
      501. Q3-5 Off
      502. Q4-1 Off
      503. Q4-2 Off
      504. Q4-3 Off
      505. Q4-4 Off
      506. Q4-5 Off
      507. Q5-1 Off
      508. Q5-2 Off
      509. Q5-3 Off
      510. Q5-4 Off
      511. Q5-5 Off
      512. R1-1 Off
      513. R1-2 Off
      514. R1-3 Off
      515. R1- Off
      516. R1-5 Off
      517. R2-1 Off
      518. R2-2 Off
      519. R2-3 Off
      520. R2-4 Off
      521. R2-5 Off
      522. R3-1 Off
      523. R3-2 Off
      524. R3-3 Off
      525. R3-4 Off
      526. R3-5 Off
      527. S1-1 Off
      528. S1-2 Off
      529. S2-1 Off
      530. S2-2 Off
      531. S3-1 Off
      532. S3-2 Off
      533. S4-1 Off
      534. S4-2 Off
      535. S5-1 Off
      536. S5-2 Off
      537. S6-1 Off
      538. S6-2 Off
      539. S7-1 Off
      540. S7-2 Off
      541. T1-1 Off
      542. T1-2 Off
      543. T1-3 Off
      544. T1-4 Off
      545. T1-5 Off
      546. T2-1 Off
      547. T2-2 Off
      548. T2-3 Off
      549. T2-4 Off
      550. T2-5 Off
      551. T3-1 Off
      552. T3-2 Off
      553. T3-3 Off
      554. T3-4 Off
      555. T3-5 Off
      556. T4-1 Off
      557. T4-2 Off
      558. T4-3 Off
      559. T4-4 Off
      560. T4-5 Off
      561. T5-1 Off
      562. T5-2 Off
      563. T5- Off
      564. T5-4 Off
      565. T5-5 Off
      566. T6-1 Off
      567. T6-2 Off
      568. T6-3 Off
      569. T6-4 Off
      570. T6-5 Off
      571. T7-1 Off
      572. T7-2 Off
      573. T7-3 Off
      574. T7-4 Off
      575. T7-5 Off
      576. T8-1 Off
      577. T8-2 Off
      578. T8-3 Off
      579. T8-4 Off
      580. T8-5 Off
      581. T9-1 Off
      582. T9-2 Off
      583. T9-3 Off
      584. T9-4 Off
      585. T9-5 Off
      586. U1-1 Off
      587. U1-2 Off
      588. U1-3 Off
      589. U1-4 Off
      590. U1-5 Off
      591. U2-1 Off
      592. U2-2 Off
      593. U2-3 Off
      594. U2-4 Off
      595. U2-5 Off
      596. U3-1 Off
      597. U3-2 Off
      598. U3-3 Off
      599. U3-4 Off
      600. U3-5 Off
      601. U4-1 Off
      602. U4-2 Off
      603. U4-3 Off
      604. U4-4 Off
      605. U4-5 Off
      606. Text Field 1
Page 4: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Participant ID

Transportation amp warehouse (for example aviation specialists including pilots and controllers postal service and delivery logistics couriers driver moving materials factory worker packing and distribution) Government public administration amp military (for example military or combat personnel national security or international afairs consultants or contractors and other government and support personnel) Police fire or other protective services (for example safety officer security correctional officer) Retail sales amp customer care (for example cashier customer service car sales real estate including rentalleasingselling broker landlord or other sales-related work) Hospitality service amp food management (for example housekeeping cook food preparation and service bartender server) Administration (for example human resources project management stafngemployment services and other ofce and administrative support personnel) Personal care (for example hairdresser cosmetologist barber ftness trainer and other personal services) Education amp other training-related work (for example teacher professor librarian academic advisor professional coach and other educational support services) Community amp social services (for example individual and family service provider child day care provider religious services including pastor clergy priest and other church ministry personnel) Arts entertainment media amp recreation (for example performing arts art galleries sports centers amusement and gambling industries) Computer information technology amp other technical services (for example newspaper or software publisher telecommunications data processing broadcasting computer design advertising) Healthcare practitioner therapist or support staff ( for example physician dentist chiropractor counselor nurse EMT residential care specialist) Architecture engineering amp science professionals Legal services (for example lawyer clerk or other legal work) Business amp financial operations (for example banking accounting auditing compliance officers claims processor quality assurance management financial and insurance services) Other (Please specify)

A6 Which best describes your position within your feld If you are not sure please make your best guess

Entry-level Mid-level Upper-level

A7 How long have you been in your current job (If you have more than one job please respond to this question with respect to your primary job)

years months

Well-Being Inventory (05 August 2019) National Center for PTSD Page 2 of 23

Participant ID

ADMINISTRATOR ASK OF EVERYONE

A8 Do you do any of the following types of unpaid work Mark all that apply I do not do any unpaid work Full-time care of children under the age of 18 Full-time care of an adult (for example spouseparentdisabled child over 18) Full-time homemaker without full-time child or elder care responsibilities Volunteer work (excluding time spent helping friends relatives andor neighbors)

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT WORKING FOR PAY BUT ACTIVELY LOOKING FOR PAID WORK IN A1

A9 What is the main reason you have not been working for pay Laid off Fired Quit my previous job Was unable to work due to medical problems Was in school or other training program Other reason (please specify)

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT WORKING FOR PAY AND NOT LOOKING FOR PAID WORK IN A1

A10 What is the main reason you are not looking for paid work Unable to work because of an injury or illness Unable to work because of an ongoing physical health condition or disability Unable to work because of an ongoing mentalemotional condition or disability Unable to find work Retired from the workforce Full-time homemaker andor caregiver In schooltraining Not interested in paid employment Other reason (please specify)

ADMINISTRATOR ASK OF ALL THOSE WHO INDICATED THAT THEY VOLUNTEER IN A8

A11 In a typical week how many hours of unpaid volunteer work do you do

A12 What type(s) of organization(s) do you volunteer for Mark all that apply Civic political professional or international Educational school or youth service Environmental or animal care Hospital or other health organization Public safety emergency services Religious

Well-Being Inventory (05 August 2019) National Center for PTSD Page 3 of 23

Participant ID

Social or community service Sport hobby cultural arts Veteran service organization Other (please specify)

A13 What type(s) of volunteer work do you do Mark all that apply Coach referee or supervise sports teams Tutor or teach Mentor youth or peers Usher greeter or minister Collect prepare distribute or serve food Fundraise or sell items to raise money Provide counseling medical care fire or protective services Provide general office services Provide professional or management assistance including serving on a board or committee Engage in music performance or other artistic activities Engage in general labor andor supply transportation to people Other (please specify)

SECTION 1B

ADMINISTRATOR ASK OF THOSE WHO INDICATE WORKING FOR PAY VOLUNTEERING OR CAREGIVING HOMEMAKING IN A1ampA8

Please answer the next questions with respect to the PRIMARY WORK you have done over the last 3 months For fulltime homemakers andor unpaid caregivers meal preparation household maintenance andor child-rearing may be considered your work For volunteers without paid employment volunteer work is considered your work

Over the last 3 months please indicate how often

Never Rarely Sometimes Often Most

or all of the time

B1 You completed your work when expected (for example attending work regularly completing tasks on time)

1 2 3 4 5

B2 You went above and beyond in your work (for example completing required tasks ahead of schedule taking on extra responsibilities)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 4 of 23

Participant ID

Over the last 3 months please indicate how often

Never Rarely Sometimes Often Most

or all of the time

B3 You maintained positive relationships with others in your work setting (for example avoiding confict when possible being patient with coworkers)

1 2 3 4 5

B4 The quality of your work was excellent

1 2 3 4 5

SECTION 1C

ADMINISTRATOR ASK OF THOSE WHO INDICATE WORKING FOR PAY IN A1

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

C1 Your pay and benefits 1 2 3 4 5

C2 Your work environment (for example people you work with work setting)

1 2 3 4 5

ADMINISTRATOR ASK OF THOSE WHO INDICATE WORKING FOR PAY VOLUNTEERING OR CAREGIVINGHOMEMAKING IN A1ampA8

Please answer the next questions with respect to the PRIMARY WORK you have done over the last 3 months For fulltime homemakers andor unpaid caregivers please note that meal preparation household maintenance andor child-rearing are considered your work For volunteers volunteer work is considered your work

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

C3 The kind of work you do 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 5 of 23

Participant ID

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

C4 How much your work contributions are valued

1 2 3 4 5

C5 Your ability to advance your vocational goals in your current role

1 2 3 4 5

C6 Your ability to apply your skills and knowledge to your work

1 2 3 4 5

SECTION 1D

In this next section you will be asked about your educational and training experiences

D1 Are you currently pursuing additional education or attending a trade or technicalvocational school (excluding on-the-job training)

Yes full-time (12 or more credits of coursework if in university setting) Yes part-time (less than 12 credits of coursework if in university setting) No

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

D2 What type of additional education or training are you pursuing High school diploma GED Technicalvocational training (for example carpentry computer programming medical technician training) Taking undergraduate courses but not enrolled in an undergraduate program Associatersquos degree (for example AA AS) Bachelorrsquos degree (for example BA BS) Taking graduate courses but not enrolled in a graduate program Masterrsquos degree (for example MA MS MEng MEd MSW MBA) Doctorate degree (for example PhD EdD) Professional degree beyond a bachelorrsquos degree (for example MD DDS DVM LLB JD)

D3 Which of the following best describes your primary feld of study in y our current education or training

Arts and humanities (for example English art history journalism) Biological sciences (for example biology environmental science) Business (for example accounting fnance)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 6 of 23

Participant ID

Education (for example elementary education special education) Computer-related (for example computer science information technology) Engineering (for example chemical or mechanical engineering) Physical science (for example chemistry statistics) Health science (for example nursing veterinary health technology) Social science (for example social work psychology) Technicalvocational training (please specify) Other (please specify)

ADMINISTRATOR ASK OF EVERYONE

D4 What is the highest degree or level of education you have completed Less than high school Some high school but no diploma or GED High school diploma GED Post-high school vocational or technical training Some college credit no degree Associatersquos degree (for example AA AS) Bachelorrsquos degree (for example BA BS) Masterrsquos degree (for example MA MS MEng MEd MSW MBA) Doctorate degree (for example PhD EdD) Professional degree beyond a bachelorrsquos degree (for example MD DDS DVM LLB JD)

SECTION 1E

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

Over the last 3 months of your education or training please indicate how often

Never Rarely Sometimes Often Most

or all of the time

E1 You completed all required courseworktraining activities

1 2 3 4 5

E2 You went above and beyond in your educational activities (for example completing assignments ahead of schedule participating in educational activities outside of class)

1 2 3 4 5

E3 You did your part to create a positive learning environment (for example contributing to discussions showing appreciation for othersrsquo viewpoints)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 7 of 23

Participant ID

Over the last 3 months of your education or training please indicate how often

Never Rarely Sometimes Often Most

or all of the time

E4 The quality of your coursework training activities was excellent

1 2 3 4 5

SECTION 1F

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

Over the last 3 months of your education or training how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

F1 The quality of your education or training experience

1 2 3 4 5

F2 The extent to which your education or training is advancing your career goals

1 2 3 4 5

F3 Your learning environment (for example teachers and other students educational setting)

1 2 3 4 5

SECTION 2 FINANCES

In the next section we ask about your fnancial cir cumstances Please remember that all information you provide is completely confden tial and will be used to better understand your fnancial w ell-being Also if you are not sure how to answer some of these questions please provide your best guess

In this set of questions your household refers to you other earners who share the majority of expenses and those who depend on this income (for example children or elders)

SECTION 2G

ADMINISTRATOR ASK OF EVERYONE

G1 Are you able to pay for all necessary expenses each month such as mortgagerent debt payments and groceries

Well-Being Inventory (05 August 2019) National Center for PTSD Page 8 of 23

Participant ID

Yes No

G2 Does your household have at least 3 months of your typical income set aside in case of an unexpected fnancial ev ent

Yes No

G3 Does your household have the insurance coverage you andor your family would need if an unexpected financial event were to occur (for example disability insurance property insurance and or life insurance)

Yes No

G4 Has your household begun to set aside money for retirement Yes No

G5 Is your household more than one month behind on your debt payments (for example mortgage or credit card)

No my household is not more than one month behind in debt payments Yes my household is over one month behind in debt payments Not applicable - my household does not have any debt

G6 Are you currently concerned that you will lose your housing and be unable to find stable alternative housing

Yes No

ADMINISTRATOR ASK OF EVERYONE

G7

G8

How many people are supported by your HOUSEHOLD income including yourself your significant other (if you have one) and anyone else partially or fully supported by this income whether or not they live with you

What is your current living situation Rent an apartment house or room Own an apartment or house Live with a friend or relative and not paying rent Live in a dormitory at school Live in a medical or assisted living facility such as a hospital or rehab center Live in transitional housing (for example a halfway house) Live in a car on the street or in a homeless shelter

Well-Being Inventory (05 August 2019) National Center for PTSD Page 9 of 23

Participant ID

Somewhere else (fll-in

ADMINISTRATOR ASK OF THOSE WHO INDICATED THEY WORK FOR PAY IN A1

G9 Please provide your expected annual SALARY before taxes are taken out If you do not know your salary please indicate how much you expect to earn per hour (before taxes) If you do not know the answer please make your best guess

ANNUAL SALARY (before taxes)

-OR-

HOURLY PAY RATE (before taxes)

ADMINISTRATOR ASK OF EVERYONE

G10 Please provide an estimate of your HOUSEHOLDrsquoS yearly income before taxes are taken out Include all sources of income including salary as well as any disability payments real estate income and any other sources of income from all earners in your household If you do not have other sources of income and you are the only earner in your household this may be the same as your salary If you do not know the answer please make your best guess

$

ADMINISTRATOR ASK OF EVERYONE

G11 Approximately how much money does your household have readily available (for example in cash and savings) to cover a financial emergency such as loss of a job If you do not know the answer make your best guess

$

G12 Approximately how much does your HOUSEHOLD pay towards debt and housing expenses PER MONTH (for example mortgagerent bills credit card debt student loans etc)

$

ADMINISTRATOR ASK OF EVERYONE

SECTION 2H

Well-Being Inventory (05 August 2019) National Center for PTSD Page 10 of 22

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most or all of the time

H1 Followed a budget 1 2 3 4 5

H2 Compared prices when purchasing a product or service

1 2 3 4 5

H3 Kept a written or electronic record of your spending

1 2 3 4 5

H4 Been late in paying a bill 1 2 3 4 5

H5 Had credit card debt that you did not pay of each mon th

1 2 3 4 5

H6 Spent more than you could afford on clothing entertainment and other extras

1 2 3 4 5

H7 Contributed part of each paycheck (or other income) to a retirement account such as a 401k or IRA

1 2 3 4 5

H8 Contributed part of each paycheck (or other income) to a personal savings account

1 2 3 4 5

SECTION 2I

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I1 Your ability to pay for necessities 1 2 3 4 5

I2 Your ability to afford extras (for example vacation dinner out)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 11 of 22

Participant ID

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I3 The amount of savings you have 1 2 3 4 5

I4 The amount of debt you have 1 2 3 4 5

SECTION 3 CURRENT HEALTH

In this next section you will be asked about your current physical and emotionalmental health

SECTION 3J

ADMINISTRATOR ASK OF EVERYONE

J1 Do you have an ongoing physical health condition illness or disability (for example high blood pressure pain)

Yes No

J2 Do you have an ongoing mentalemotional health condition illness or disability (for example depression anxiety)

Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE A PHYSICAL HEALTH PROBLEM IN J1 OR A MENTAL HEALTH PROBLEM IN J2

J3 What ongoing physical or mentalemotional health conditions illnesses or disabilities do you have Mark all that apply

High blood pressure or other heart problem High cholesterol Diabetes requiring insulin other medication or special diet Obesity Sleep problem or disorder Chronic pain or pain related disorder (for example knee back migraines)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 12 of 23

Participant ID

Arthritis A hearing condition that is not correctable Alcohol or drug (including prescription drugs) abusedependence Posttraumatic stress disorder Depression Anxiety disorder (for example panic disorder generalized anxiety disorder)Other chronic physical or mental health problem 1 (please specify) Other chronic physical or mental health problem 2 (please specify) Other chronic physical or mental health problem 3 (please specify)

ADMINISTRATOR ASK OF EVERYONE

J4 Do you have healthcare coverage (for example employer-provided health insurance Medicaid) Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATED THAT THEY HAVE HEALTHCARE COVERAGE IN J4

J5 Which of the following best describe your main sources of healthcare coverage Employer-provided health insurance (could be from your current or former employer a family memberrsquos current or former employer or a union) A plan you purchased through a healthcare exchange (for example Healthcaregov State exchange Obamacare etc) TRICARE VA Medicaid Medicare Other government assisted health plan Something else (please specify)

SECTION 3K

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K1 Eaten a generally healthy diet (for example low fat limited sugar adequate servings of fruits and vegetables)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 13 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K2 Gotten at least 2 hours and 30 minutes of moderate physical activity OR 1 hour and 15 minutes of vigorous activity each week

1 2 3 4 5

K3 Done muscle strengthening exercises at least two days per week

1 2 3 4 5

K4 Gotten quality sleep 1 2 3 4 5

K5 Had sexual intercourse without a condom with more than one person or with a person you did not know

1 2 3 4 5

K6 Used tobacco andor nicotine products (for example cigarettes cigars vape)

1 2 3 4 5

K7 Used alcohol in a way that put your health at risk (for example blacking out driving drunk)

1 2 3 4 5

K8 Used drugs (including prescription drugs) in a way that put your health at risk (for example losing memory or consciousness driving under the infuence)

1 2 3 4 5

K9 Completed recommended medical care (for example physical exams)

1 2 3 4 5

K10 Maintained personal cleanliness (for example personal care household chores)

1 2 3 4 5

K11 Spent time doing things that you enjoy

1 2 3 4 5

K12 Spent time doing things that you find personally meaningful

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 14 of 23

Participant ID

SECTION 3L

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

L1 Your physical health 1 2 3 4 5

L2 Your emotionalmental health 1 2 3 4 5

L3 Your health care 1 2 3 4 5

SECTION 4 SOCIAL RELATIONSHIPS

In this next section you will be asked about your romantic relationship involvement

SECTION 4M

ADMINISTRATOR ASK OF EVERYONE

M1 What is your current marital status

Never married Married - first and only marriage Married - second or later marriage Separated Divorced Widowed

ADMINISTRATOR ASK OF THOSE WHO DID NOT INDICATE MARRIED IN M1

M2 Are you currently in a romantic relationship Currently in a relationship and living as a couple Currently in a relationship but not living as a couple Not currently in a relationship

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 15 of 23

Participant ID

M3 How long have you been married or in your current relationship years months

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT MARRIED ON M1 AND NOT IN A RELATIONSHIP ON M2

M4 Which of the following is true with respect to your romantic relationship status I would like to be in a relationship I prefer not to be in a relationship at this time

SECTION 4N

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Over the last 3 months how often have you done the following in your romantic relationship

Never Rarely Sometimes Often Most

or all of the time

N1 Provided your significant other with the emotional support they sought

1 2 3 4 5

N2 Shared your intimate thoughts and feelings

1 2 3 4 5

N3 Done your fair share of day-to-day tasks (for example grocery shopping errands planning activities)

1 2 3 4 5

N4 Initiated leisure time activities that both you and your signifcan t other enjoy

1 2 3 4 5

N5 Made ef ort to work through disagreements respectfully

1 2 3 4 5

N6 Expressed interest andor willingness to engage in regular sexual or physical intimacy

1 2 3 4 5

SECTION 4O

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 16 of 23

Participant ID

Everybody has aspects of their relationship that make them more or less happy Over the last 3 months how satisfied have you been with your significant otherrsquos contribution to the following aspects of your romantic relationship

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

O1Emotional closeness (for example sharing personal thoughts and feelings)

1 2 3 4 5

O2Companionship (for example doing enjoyable activities together)

1 2 3 4 5

O3Sexual and physical intimacy (for example holding hands or having sex)

1 2 3 4 5

O4 Intellectual connection (for example having many things to talk about)

1 2 3 4 5

O5Security (for example being able to trust and depend on partner)

1 2 3 4 5

O6Division of day-to-day tasks (for example your partnerrsquos contribution to chores and planning activities)

1 2 3 4 5

In this next section you will be asked about your parenting experiences

SECTION 4P

P1 Are you a parent or have you served in a parenting role during the past three months Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P2 Do you have children who are age 18 or younger Yes No

Well-Being Inventory (05 August 2019) National Center for PTSD Page 17 of 23

Participant ID

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P3 How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities) Enter a number on each line write 0 if you do not have any children in that age category

Number of Children

Under 5 years old

Age 5 through 12 years old

Age 13 through 18 years old

Age 19 through 26

27 years +

ADMINISTRATOR ASK OF THOSE WHO DO NOT INDICATE HAVING CHILDREN IN P1

P4 Which of the following is true with respect to your parenting status I would like to be a parent now I prefer not to be a parent at this time

SECTION 4Q

ADMINISTRATOR ASK OF ALL THOSE WHO HAVE CHILDREN UNDER 18 IN P2

Please answer the following questions with regard to children 18 or under for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 18 of 23

Participant ID

All parents have strengths and weaknesses Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

Q1Provided a healthy environment for your child(ren) (for example preparing healthy meals caring for their health keeping them safe)

1 2 3 4 5

Q2Been a good example for your child(ren) (for example being respectful during disagreements with others taking good care of your own health)

1 2 3 4 5

Q3Been actively involved in your child(ren)rsquos activities (for example regularly attending sporting and school events giving your full attention during time together)

1 2 3 4 5

Q4Met your child(ren)rsquos needs for physical affection and emotional support (for example giving them hugs being sympathetic to their problems)

1 2 3 4 5

Q5Been able to successfully manage your child(ren)rsquos unique challenges (for example efectively disciplining children)

1 2 3 4 5

SECTION 4R

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

Please answer the following questions with regard to ALL children for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 19 of 23

Participant ID

Parenting can be both rewarding and challenging How satisfed have you been with the following aspects of your parenting experiences over the last 3 months

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

R1 How close you are with your child(ren)

1 2 3 4 5

R2 How much enjoyment you get from parenting

1 2 3 4 5

R3 How your child(ren) are doing in life 1 2 3 4 5

SECTION 4S

ADMINISTRATOR ASK OF EVERYONE

In this next section you will be asked about your experiences in your broader community as well as your relationships with relatives and friends

Over the last 3 months have you regularly done the following

No Yes

S1 Participated in a religious or spiritual community

0 1

S2 Volunteered for a charity political group or other local organization (for example a service organization a political campaign)

0 1

S3 Participated in a community group that shares similar hobbies (for example a sports team a book club)

0 1

S4 Participated in a community group with shared background characteristics (for example a Veterans organization momrsquos group)

0 1

Well-Being Inventory (05 August 2019) National Center for PTSD Page 20 of 23

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
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      229. Explain living situation
      230. Annual salary
      231. Hourly
      232. estimate
      233. readily available
      234. expenses
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      313. Specify other problem2
      314. Specify other problem3
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      412. year2
      413. months2
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      606. Text Field 1
Page 5: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Participant ID

ADMINISTRATOR ASK OF EVERYONE

A8 Do you do any of the following types of unpaid work Mark all that apply I do not do any unpaid work Full-time care of children under the age of 18 Full-time care of an adult (for example spouseparentdisabled child over 18) Full-time homemaker without full-time child or elder care responsibilities Volunteer work (excluding time spent helping friends relatives andor neighbors)

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT WORKING FOR PAY BUT ACTIVELY LOOKING FOR PAID WORK IN A1

A9 What is the main reason you have not been working for pay Laid off Fired Quit my previous job Was unable to work due to medical problems Was in school or other training program Other reason (please specify)

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT WORKING FOR PAY AND NOT LOOKING FOR PAID WORK IN A1

A10 What is the main reason you are not looking for paid work Unable to work because of an injury or illness Unable to work because of an ongoing physical health condition or disability Unable to work because of an ongoing mentalemotional condition or disability Unable to find work Retired from the workforce Full-time homemaker andor caregiver In schooltraining Not interested in paid employment Other reason (please specify)

ADMINISTRATOR ASK OF ALL THOSE WHO INDICATED THAT THEY VOLUNTEER IN A8

A11 In a typical week how many hours of unpaid volunteer work do you do

A12 What type(s) of organization(s) do you volunteer for Mark all that apply Civic political professional or international Educational school or youth service Environmental or animal care Hospital or other health organization Public safety emergency services Religious

Well-Being Inventory (05 August 2019) National Center for PTSD Page 3 of 23

Participant ID

Social or community service Sport hobby cultural arts Veteran service organization Other (please specify)

A13 What type(s) of volunteer work do you do Mark all that apply Coach referee or supervise sports teams Tutor or teach Mentor youth or peers Usher greeter or minister Collect prepare distribute or serve food Fundraise or sell items to raise money Provide counseling medical care fire or protective services Provide general office services Provide professional or management assistance including serving on a board or committee Engage in music performance or other artistic activities Engage in general labor andor supply transportation to people Other (please specify)

SECTION 1B

ADMINISTRATOR ASK OF THOSE WHO INDICATE WORKING FOR PAY VOLUNTEERING OR CAREGIVING HOMEMAKING IN A1ampA8

Please answer the next questions with respect to the PRIMARY WORK you have done over the last 3 months For fulltime homemakers andor unpaid caregivers meal preparation household maintenance andor child-rearing may be considered your work For volunteers without paid employment volunteer work is considered your work

Over the last 3 months please indicate how often

Never Rarely Sometimes Often Most

or all of the time

B1 You completed your work when expected (for example attending work regularly completing tasks on time)

1 2 3 4 5

B2 You went above and beyond in your work (for example completing required tasks ahead of schedule taking on extra responsibilities)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 4 of 23

Participant ID

Over the last 3 months please indicate how often

Never Rarely Sometimes Often Most

or all of the time

B3 You maintained positive relationships with others in your work setting (for example avoiding confict when possible being patient with coworkers)

1 2 3 4 5

B4 The quality of your work was excellent

1 2 3 4 5

SECTION 1C

ADMINISTRATOR ASK OF THOSE WHO INDICATE WORKING FOR PAY IN A1

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

C1 Your pay and benefits 1 2 3 4 5

C2 Your work environment (for example people you work with work setting)

1 2 3 4 5

ADMINISTRATOR ASK OF THOSE WHO INDICATE WORKING FOR PAY VOLUNTEERING OR CAREGIVINGHOMEMAKING IN A1ampA8

Please answer the next questions with respect to the PRIMARY WORK you have done over the last 3 months For fulltime homemakers andor unpaid caregivers please note that meal preparation household maintenance andor child-rearing are considered your work For volunteers volunteer work is considered your work

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

C3 The kind of work you do 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 5 of 23

Participant ID

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

C4 How much your work contributions are valued

1 2 3 4 5

C5 Your ability to advance your vocational goals in your current role

1 2 3 4 5

C6 Your ability to apply your skills and knowledge to your work

1 2 3 4 5

SECTION 1D

In this next section you will be asked about your educational and training experiences

D1 Are you currently pursuing additional education or attending a trade or technicalvocational school (excluding on-the-job training)

Yes full-time (12 or more credits of coursework if in university setting) Yes part-time (less than 12 credits of coursework if in university setting) No

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

D2 What type of additional education or training are you pursuing High school diploma GED Technicalvocational training (for example carpentry computer programming medical technician training) Taking undergraduate courses but not enrolled in an undergraduate program Associatersquos degree (for example AA AS) Bachelorrsquos degree (for example BA BS) Taking graduate courses but not enrolled in a graduate program Masterrsquos degree (for example MA MS MEng MEd MSW MBA) Doctorate degree (for example PhD EdD) Professional degree beyond a bachelorrsquos degree (for example MD DDS DVM LLB JD)

D3 Which of the following best describes your primary feld of study in y our current education or training

Arts and humanities (for example English art history journalism) Biological sciences (for example biology environmental science) Business (for example accounting fnance)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 6 of 23

Participant ID

Education (for example elementary education special education) Computer-related (for example computer science information technology) Engineering (for example chemical or mechanical engineering) Physical science (for example chemistry statistics) Health science (for example nursing veterinary health technology) Social science (for example social work psychology) Technicalvocational training (please specify) Other (please specify)

ADMINISTRATOR ASK OF EVERYONE

D4 What is the highest degree or level of education you have completed Less than high school Some high school but no diploma or GED High school diploma GED Post-high school vocational or technical training Some college credit no degree Associatersquos degree (for example AA AS) Bachelorrsquos degree (for example BA BS) Masterrsquos degree (for example MA MS MEng MEd MSW MBA) Doctorate degree (for example PhD EdD) Professional degree beyond a bachelorrsquos degree (for example MD DDS DVM LLB JD)

SECTION 1E

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

Over the last 3 months of your education or training please indicate how often

Never Rarely Sometimes Often Most

or all of the time

E1 You completed all required courseworktraining activities

1 2 3 4 5

E2 You went above and beyond in your educational activities (for example completing assignments ahead of schedule participating in educational activities outside of class)

1 2 3 4 5

E3 You did your part to create a positive learning environment (for example contributing to discussions showing appreciation for othersrsquo viewpoints)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 7 of 23

Participant ID

Over the last 3 months of your education or training please indicate how often

Never Rarely Sometimes Often Most

or all of the time

E4 The quality of your coursework training activities was excellent

1 2 3 4 5

SECTION 1F

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

Over the last 3 months of your education or training how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

F1 The quality of your education or training experience

1 2 3 4 5

F2 The extent to which your education or training is advancing your career goals

1 2 3 4 5

F3 Your learning environment (for example teachers and other students educational setting)

1 2 3 4 5

SECTION 2 FINANCES

In the next section we ask about your fnancial cir cumstances Please remember that all information you provide is completely confden tial and will be used to better understand your fnancial w ell-being Also if you are not sure how to answer some of these questions please provide your best guess

In this set of questions your household refers to you other earners who share the majority of expenses and those who depend on this income (for example children or elders)

SECTION 2G

ADMINISTRATOR ASK OF EVERYONE

G1 Are you able to pay for all necessary expenses each month such as mortgagerent debt payments and groceries

Well-Being Inventory (05 August 2019) National Center for PTSD Page 8 of 23

Participant ID

Yes No

G2 Does your household have at least 3 months of your typical income set aside in case of an unexpected fnancial ev ent

Yes No

G3 Does your household have the insurance coverage you andor your family would need if an unexpected financial event were to occur (for example disability insurance property insurance and or life insurance)

Yes No

G4 Has your household begun to set aside money for retirement Yes No

G5 Is your household more than one month behind on your debt payments (for example mortgage or credit card)

No my household is not more than one month behind in debt payments Yes my household is over one month behind in debt payments Not applicable - my household does not have any debt

G6 Are you currently concerned that you will lose your housing and be unable to find stable alternative housing

Yes No

ADMINISTRATOR ASK OF EVERYONE

G7

G8

How many people are supported by your HOUSEHOLD income including yourself your significant other (if you have one) and anyone else partially or fully supported by this income whether or not they live with you

What is your current living situation Rent an apartment house or room Own an apartment or house Live with a friend or relative and not paying rent Live in a dormitory at school Live in a medical or assisted living facility such as a hospital or rehab center Live in transitional housing (for example a halfway house) Live in a car on the street or in a homeless shelter

Well-Being Inventory (05 August 2019) National Center for PTSD Page 9 of 23

Participant ID

Somewhere else (fll-in

ADMINISTRATOR ASK OF THOSE WHO INDICATED THEY WORK FOR PAY IN A1

G9 Please provide your expected annual SALARY before taxes are taken out If you do not know your salary please indicate how much you expect to earn per hour (before taxes) If you do not know the answer please make your best guess

ANNUAL SALARY (before taxes)

-OR-

HOURLY PAY RATE (before taxes)

ADMINISTRATOR ASK OF EVERYONE

G10 Please provide an estimate of your HOUSEHOLDrsquoS yearly income before taxes are taken out Include all sources of income including salary as well as any disability payments real estate income and any other sources of income from all earners in your household If you do not have other sources of income and you are the only earner in your household this may be the same as your salary If you do not know the answer please make your best guess

$

ADMINISTRATOR ASK OF EVERYONE

G11 Approximately how much money does your household have readily available (for example in cash and savings) to cover a financial emergency such as loss of a job If you do not know the answer make your best guess

$

G12 Approximately how much does your HOUSEHOLD pay towards debt and housing expenses PER MONTH (for example mortgagerent bills credit card debt student loans etc)

$

ADMINISTRATOR ASK OF EVERYONE

SECTION 2H

Well-Being Inventory (05 August 2019) National Center for PTSD Page 10 of 22

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most or all of the time

H1 Followed a budget 1 2 3 4 5

H2 Compared prices when purchasing a product or service

1 2 3 4 5

H3 Kept a written or electronic record of your spending

1 2 3 4 5

H4 Been late in paying a bill 1 2 3 4 5

H5 Had credit card debt that you did not pay of each mon th

1 2 3 4 5

H6 Spent more than you could afford on clothing entertainment and other extras

1 2 3 4 5

H7 Contributed part of each paycheck (or other income) to a retirement account such as a 401k or IRA

1 2 3 4 5

H8 Contributed part of each paycheck (or other income) to a personal savings account

1 2 3 4 5

SECTION 2I

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I1 Your ability to pay for necessities 1 2 3 4 5

I2 Your ability to afford extras (for example vacation dinner out)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 11 of 22

Participant ID

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I3 The amount of savings you have 1 2 3 4 5

I4 The amount of debt you have 1 2 3 4 5

SECTION 3 CURRENT HEALTH

In this next section you will be asked about your current physical and emotionalmental health

SECTION 3J

ADMINISTRATOR ASK OF EVERYONE

J1 Do you have an ongoing physical health condition illness or disability (for example high blood pressure pain)

Yes No

J2 Do you have an ongoing mentalemotional health condition illness or disability (for example depression anxiety)

Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE A PHYSICAL HEALTH PROBLEM IN J1 OR A MENTAL HEALTH PROBLEM IN J2

J3 What ongoing physical or mentalemotional health conditions illnesses or disabilities do you have Mark all that apply

High blood pressure or other heart problem High cholesterol Diabetes requiring insulin other medication or special diet Obesity Sleep problem or disorder Chronic pain or pain related disorder (for example knee back migraines)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 12 of 23

Participant ID

Arthritis A hearing condition that is not correctable Alcohol or drug (including prescription drugs) abusedependence Posttraumatic stress disorder Depression Anxiety disorder (for example panic disorder generalized anxiety disorder)Other chronic physical or mental health problem 1 (please specify) Other chronic physical or mental health problem 2 (please specify) Other chronic physical or mental health problem 3 (please specify)

ADMINISTRATOR ASK OF EVERYONE

J4 Do you have healthcare coverage (for example employer-provided health insurance Medicaid) Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATED THAT THEY HAVE HEALTHCARE COVERAGE IN J4

J5 Which of the following best describe your main sources of healthcare coverage Employer-provided health insurance (could be from your current or former employer a family memberrsquos current or former employer or a union) A plan you purchased through a healthcare exchange (for example Healthcaregov State exchange Obamacare etc) TRICARE VA Medicaid Medicare Other government assisted health plan Something else (please specify)

SECTION 3K

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K1 Eaten a generally healthy diet (for example low fat limited sugar adequate servings of fruits and vegetables)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 13 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K2 Gotten at least 2 hours and 30 minutes of moderate physical activity OR 1 hour and 15 minutes of vigorous activity each week

1 2 3 4 5

K3 Done muscle strengthening exercises at least two days per week

1 2 3 4 5

K4 Gotten quality sleep 1 2 3 4 5

K5 Had sexual intercourse without a condom with more than one person or with a person you did not know

1 2 3 4 5

K6 Used tobacco andor nicotine products (for example cigarettes cigars vape)

1 2 3 4 5

K7 Used alcohol in a way that put your health at risk (for example blacking out driving drunk)

1 2 3 4 5

K8 Used drugs (including prescription drugs) in a way that put your health at risk (for example losing memory or consciousness driving under the infuence)

1 2 3 4 5

K9 Completed recommended medical care (for example physical exams)

1 2 3 4 5

K10 Maintained personal cleanliness (for example personal care household chores)

1 2 3 4 5

K11 Spent time doing things that you enjoy

1 2 3 4 5

K12 Spent time doing things that you find personally meaningful

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 14 of 23

Participant ID

SECTION 3L

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

L1 Your physical health 1 2 3 4 5

L2 Your emotionalmental health 1 2 3 4 5

L3 Your health care 1 2 3 4 5

SECTION 4 SOCIAL RELATIONSHIPS

In this next section you will be asked about your romantic relationship involvement

SECTION 4M

ADMINISTRATOR ASK OF EVERYONE

M1 What is your current marital status

Never married Married - first and only marriage Married - second or later marriage Separated Divorced Widowed

ADMINISTRATOR ASK OF THOSE WHO DID NOT INDICATE MARRIED IN M1

M2 Are you currently in a romantic relationship Currently in a relationship and living as a couple Currently in a relationship but not living as a couple Not currently in a relationship

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 15 of 23

Participant ID

M3 How long have you been married or in your current relationship years months

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT MARRIED ON M1 AND NOT IN A RELATIONSHIP ON M2

M4 Which of the following is true with respect to your romantic relationship status I would like to be in a relationship I prefer not to be in a relationship at this time

SECTION 4N

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Over the last 3 months how often have you done the following in your romantic relationship

Never Rarely Sometimes Often Most

or all of the time

N1 Provided your significant other with the emotional support they sought

1 2 3 4 5

N2 Shared your intimate thoughts and feelings

1 2 3 4 5

N3 Done your fair share of day-to-day tasks (for example grocery shopping errands planning activities)

1 2 3 4 5

N4 Initiated leisure time activities that both you and your signifcan t other enjoy

1 2 3 4 5

N5 Made ef ort to work through disagreements respectfully

1 2 3 4 5

N6 Expressed interest andor willingness to engage in regular sexual or physical intimacy

1 2 3 4 5

SECTION 4O

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 16 of 23

Participant ID

Everybody has aspects of their relationship that make them more or less happy Over the last 3 months how satisfied have you been with your significant otherrsquos contribution to the following aspects of your romantic relationship

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

O1Emotional closeness (for example sharing personal thoughts and feelings)

1 2 3 4 5

O2Companionship (for example doing enjoyable activities together)

1 2 3 4 5

O3Sexual and physical intimacy (for example holding hands or having sex)

1 2 3 4 5

O4 Intellectual connection (for example having many things to talk about)

1 2 3 4 5

O5Security (for example being able to trust and depend on partner)

1 2 3 4 5

O6Division of day-to-day tasks (for example your partnerrsquos contribution to chores and planning activities)

1 2 3 4 5

In this next section you will be asked about your parenting experiences

SECTION 4P

P1 Are you a parent or have you served in a parenting role during the past three months Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P2 Do you have children who are age 18 or younger Yes No

Well-Being Inventory (05 August 2019) National Center for PTSD Page 17 of 23

Participant ID

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P3 How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities) Enter a number on each line write 0 if you do not have any children in that age category

Number of Children

Under 5 years old

Age 5 through 12 years old

Age 13 through 18 years old

Age 19 through 26

27 years +

ADMINISTRATOR ASK OF THOSE WHO DO NOT INDICATE HAVING CHILDREN IN P1

P4 Which of the following is true with respect to your parenting status I would like to be a parent now I prefer not to be a parent at this time

SECTION 4Q

ADMINISTRATOR ASK OF ALL THOSE WHO HAVE CHILDREN UNDER 18 IN P2

Please answer the following questions with regard to children 18 or under for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 18 of 23

Participant ID

All parents have strengths and weaknesses Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

Q1Provided a healthy environment for your child(ren) (for example preparing healthy meals caring for their health keeping them safe)

1 2 3 4 5

Q2Been a good example for your child(ren) (for example being respectful during disagreements with others taking good care of your own health)

1 2 3 4 5

Q3Been actively involved in your child(ren)rsquos activities (for example regularly attending sporting and school events giving your full attention during time together)

1 2 3 4 5

Q4Met your child(ren)rsquos needs for physical affection and emotional support (for example giving them hugs being sympathetic to their problems)

1 2 3 4 5

Q5Been able to successfully manage your child(ren)rsquos unique challenges (for example efectively disciplining children)

1 2 3 4 5

SECTION 4R

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

Please answer the following questions with regard to ALL children for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 19 of 23

Participant ID

Parenting can be both rewarding and challenging How satisfed have you been with the following aspects of your parenting experiences over the last 3 months

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

R1 How close you are with your child(ren)

1 2 3 4 5

R2 How much enjoyment you get from parenting

1 2 3 4 5

R3 How your child(ren) are doing in life 1 2 3 4 5

SECTION 4S

ADMINISTRATOR ASK OF EVERYONE

In this next section you will be asked about your experiences in your broader community as well as your relationships with relatives and friends

Over the last 3 months have you regularly done the following

No Yes

S1 Participated in a religious or spiritual community

0 1

S2 Volunteered for a charity political group or other local organization (for example a service organization a political campaign)

0 1

S3 Participated in a community group that shares similar hobbies (for example a sports team a book club)

0 1

S4 Participated in a community group with shared background characteristics (for example a Veterans organization momrsquos group)

0 1

Well-Being Inventory (05 August 2019) National Center for PTSD Page 20 of 23

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
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      230. Annual salary
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      232. estimate
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      606. Text Field 1
Page 6: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Participant ID

Social or community service Sport hobby cultural arts Veteran service organization Other (please specify)

A13 What type(s) of volunteer work do you do Mark all that apply Coach referee or supervise sports teams Tutor or teach Mentor youth or peers Usher greeter or minister Collect prepare distribute or serve food Fundraise or sell items to raise money Provide counseling medical care fire or protective services Provide general office services Provide professional or management assistance including serving on a board or committee Engage in music performance or other artistic activities Engage in general labor andor supply transportation to people Other (please specify)

SECTION 1B

ADMINISTRATOR ASK OF THOSE WHO INDICATE WORKING FOR PAY VOLUNTEERING OR CAREGIVING HOMEMAKING IN A1ampA8

Please answer the next questions with respect to the PRIMARY WORK you have done over the last 3 months For fulltime homemakers andor unpaid caregivers meal preparation household maintenance andor child-rearing may be considered your work For volunteers without paid employment volunteer work is considered your work

Over the last 3 months please indicate how often

Never Rarely Sometimes Often Most

or all of the time

B1 You completed your work when expected (for example attending work regularly completing tasks on time)

1 2 3 4 5

B2 You went above and beyond in your work (for example completing required tasks ahead of schedule taking on extra responsibilities)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 4 of 23

Participant ID

Over the last 3 months please indicate how often

Never Rarely Sometimes Often Most

or all of the time

B3 You maintained positive relationships with others in your work setting (for example avoiding confict when possible being patient with coworkers)

1 2 3 4 5

B4 The quality of your work was excellent

1 2 3 4 5

SECTION 1C

ADMINISTRATOR ASK OF THOSE WHO INDICATE WORKING FOR PAY IN A1

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

C1 Your pay and benefits 1 2 3 4 5

C2 Your work environment (for example people you work with work setting)

1 2 3 4 5

ADMINISTRATOR ASK OF THOSE WHO INDICATE WORKING FOR PAY VOLUNTEERING OR CAREGIVINGHOMEMAKING IN A1ampA8

Please answer the next questions with respect to the PRIMARY WORK you have done over the last 3 months For fulltime homemakers andor unpaid caregivers please note that meal preparation household maintenance andor child-rearing are considered your work For volunteers volunteer work is considered your work

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

C3 The kind of work you do 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 5 of 23

Participant ID

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

C4 How much your work contributions are valued

1 2 3 4 5

C5 Your ability to advance your vocational goals in your current role

1 2 3 4 5

C6 Your ability to apply your skills and knowledge to your work

1 2 3 4 5

SECTION 1D

In this next section you will be asked about your educational and training experiences

D1 Are you currently pursuing additional education or attending a trade or technicalvocational school (excluding on-the-job training)

Yes full-time (12 or more credits of coursework if in university setting) Yes part-time (less than 12 credits of coursework if in university setting) No

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

D2 What type of additional education or training are you pursuing High school diploma GED Technicalvocational training (for example carpentry computer programming medical technician training) Taking undergraduate courses but not enrolled in an undergraduate program Associatersquos degree (for example AA AS) Bachelorrsquos degree (for example BA BS) Taking graduate courses but not enrolled in a graduate program Masterrsquos degree (for example MA MS MEng MEd MSW MBA) Doctorate degree (for example PhD EdD) Professional degree beyond a bachelorrsquos degree (for example MD DDS DVM LLB JD)

D3 Which of the following best describes your primary feld of study in y our current education or training

Arts and humanities (for example English art history journalism) Biological sciences (for example biology environmental science) Business (for example accounting fnance)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 6 of 23

Participant ID

Education (for example elementary education special education) Computer-related (for example computer science information technology) Engineering (for example chemical or mechanical engineering) Physical science (for example chemistry statistics) Health science (for example nursing veterinary health technology) Social science (for example social work psychology) Technicalvocational training (please specify) Other (please specify)

ADMINISTRATOR ASK OF EVERYONE

D4 What is the highest degree or level of education you have completed Less than high school Some high school but no diploma or GED High school diploma GED Post-high school vocational or technical training Some college credit no degree Associatersquos degree (for example AA AS) Bachelorrsquos degree (for example BA BS) Masterrsquos degree (for example MA MS MEng MEd MSW MBA) Doctorate degree (for example PhD EdD) Professional degree beyond a bachelorrsquos degree (for example MD DDS DVM LLB JD)

SECTION 1E

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

Over the last 3 months of your education or training please indicate how often

Never Rarely Sometimes Often Most

or all of the time

E1 You completed all required courseworktraining activities

1 2 3 4 5

E2 You went above and beyond in your educational activities (for example completing assignments ahead of schedule participating in educational activities outside of class)

1 2 3 4 5

E3 You did your part to create a positive learning environment (for example contributing to discussions showing appreciation for othersrsquo viewpoints)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 7 of 23

Participant ID

Over the last 3 months of your education or training please indicate how often

Never Rarely Sometimes Often Most

or all of the time

E4 The quality of your coursework training activities was excellent

1 2 3 4 5

SECTION 1F

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

Over the last 3 months of your education or training how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

F1 The quality of your education or training experience

1 2 3 4 5

F2 The extent to which your education or training is advancing your career goals

1 2 3 4 5

F3 Your learning environment (for example teachers and other students educational setting)

1 2 3 4 5

SECTION 2 FINANCES

In the next section we ask about your fnancial cir cumstances Please remember that all information you provide is completely confden tial and will be used to better understand your fnancial w ell-being Also if you are not sure how to answer some of these questions please provide your best guess

In this set of questions your household refers to you other earners who share the majority of expenses and those who depend on this income (for example children or elders)

SECTION 2G

ADMINISTRATOR ASK OF EVERYONE

G1 Are you able to pay for all necessary expenses each month such as mortgagerent debt payments and groceries

Well-Being Inventory (05 August 2019) National Center for PTSD Page 8 of 23

Participant ID

Yes No

G2 Does your household have at least 3 months of your typical income set aside in case of an unexpected fnancial ev ent

Yes No

G3 Does your household have the insurance coverage you andor your family would need if an unexpected financial event were to occur (for example disability insurance property insurance and or life insurance)

Yes No

G4 Has your household begun to set aside money for retirement Yes No

G5 Is your household more than one month behind on your debt payments (for example mortgage or credit card)

No my household is not more than one month behind in debt payments Yes my household is over one month behind in debt payments Not applicable - my household does not have any debt

G6 Are you currently concerned that you will lose your housing and be unable to find stable alternative housing

Yes No

ADMINISTRATOR ASK OF EVERYONE

G7

G8

How many people are supported by your HOUSEHOLD income including yourself your significant other (if you have one) and anyone else partially or fully supported by this income whether or not they live with you

What is your current living situation Rent an apartment house or room Own an apartment or house Live with a friend or relative and not paying rent Live in a dormitory at school Live in a medical or assisted living facility such as a hospital or rehab center Live in transitional housing (for example a halfway house) Live in a car on the street or in a homeless shelter

Well-Being Inventory (05 August 2019) National Center for PTSD Page 9 of 23

Participant ID

Somewhere else (fll-in

ADMINISTRATOR ASK OF THOSE WHO INDICATED THEY WORK FOR PAY IN A1

G9 Please provide your expected annual SALARY before taxes are taken out If you do not know your salary please indicate how much you expect to earn per hour (before taxes) If you do not know the answer please make your best guess

ANNUAL SALARY (before taxes)

-OR-

HOURLY PAY RATE (before taxes)

ADMINISTRATOR ASK OF EVERYONE

G10 Please provide an estimate of your HOUSEHOLDrsquoS yearly income before taxes are taken out Include all sources of income including salary as well as any disability payments real estate income and any other sources of income from all earners in your household If you do not have other sources of income and you are the only earner in your household this may be the same as your salary If you do not know the answer please make your best guess

$

ADMINISTRATOR ASK OF EVERYONE

G11 Approximately how much money does your household have readily available (for example in cash and savings) to cover a financial emergency such as loss of a job If you do not know the answer make your best guess

$

G12 Approximately how much does your HOUSEHOLD pay towards debt and housing expenses PER MONTH (for example mortgagerent bills credit card debt student loans etc)

$

ADMINISTRATOR ASK OF EVERYONE

SECTION 2H

Well-Being Inventory (05 August 2019) National Center for PTSD Page 10 of 22

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most or all of the time

H1 Followed a budget 1 2 3 4 5

H2 Compared prices when purchasing a product or service

1 2 3 4 5

H3 Kept a written or electronic record of your spending

1 2 3 4 5

H4 Been late in paying a bill 1 2 3 4 5

H5 Had credit card debt that you did not pay of each mon th

1 2 3 4 5

H6 Spent more than you could afford on clothing entertainment and other extras

1 2 3 4 5

H7 Contributed part of each paycheck (or other income) to a retirement account such as a 401k or IRA

1 2 3 4 5

H8 Contributed part of each paycheck (or other income) to a personal savings account

1 2 3 4 5

SECTION 2I

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I1 Your ability to pay for necessities 1 2 3 4 5

I2 Your ability to afford extras (for example vacation dinner out)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 11 of 22

Participant ID

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I3 The amount of savings you have 1 2 3 4 5

I4 The amount of debt you have 1 2 3 4 5

SECTION 3 CURRENT HEALTH

In this next section you will be asked about your current physical and emotionalmental health

SECTION 3J

ADMINISTRATOR ASK OF EVERYONE

J1 Do you have an ongoing physical health condition illness or disability (for example high blood pressure pain)

Yes No

J2 Do you have an ongoing mentalemotional health condition illness or disability (for example depression anxiety)

Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE A PHYSICAL HEALTH PROBLEM IN J1 OR A MENTAL HEALTH PROBLEM IN J2

J3 What ongoing physical or mentalemotional health conditions illnesses or disabilities do you have Mark all that apply

High blood pressure or other heart problem High cholesterol Diabetes requiring insulin other medication or special diet Obesity Sleep problem or disorder Chronic pain or pain related disorder (for example knee back migraines)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 12 of 23

Participant ID

Arthritis A hearing condition that is not correctable Alcohol or drug (including prescription drugs) abusedependence Posttraumatic stress disorder Depression Anxiety disorder (for example panic disorder generalized anxiety disorder)Other chronic physical or mental health problem 1 (please specify) Other chronic physical or mental health problem 2 (please specify) Other chronic physical or mental health problem 3 (please specify)

ADMINISTRATOR ASK OF EVERYONE

J4 Do you have healthcare coverage (for example employer-provided health insurance Medicaid) Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATED THAT THEY HAVE HEALTHCARE COVERAGE IN J4

J5 Which of the following best describe your main sources of healthcare coverage Employer-provided health insurance (could be from your current or former employer a family memberrsquos current or former employer or a union) A plan you purchased through a healthcare exchange (for example Healthcaregov State exchange Obamacare etc) TRICARE VA Medicaid Medicare Other government assisted health plan Something else (please specify)

SECTION 3K

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K1 Eaten a generally healthy diet (for example low fat limited sugar adequate servings of fruits and vegetables)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 13 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K2 Gotten at least 2 hours and 30 minutes of moderate physical activity OR 1 hour and 15 minutes of vigorous activity each week

1 2 3 4 5

K3 Done muscle strengthening exercises at least two days per week

1 2 3 4 5

K4 Gotten quality sleep 1 2 3 4 5

K5 Had sexual intercourse without a condom with more than one person or with a person you did not know

1 2 3 4 5

K6 Used tobacco andor nicotine products (for example cigarettes cigars vape)

1 2 3 4 5

K7 Used alcohol in a way that put your health at risk (for example blacking out driving drunk)

1 2 3 4 5

K8 Used drugs (including prescription drugs) in a way that put your health at risk (for example losing memory or consciousness driving under the infuence)

1 2 3 4 5

K9 Completed recommended medical care (for example physical exams)

1 2 3 4 5

K10 Maintained personal cleanliness (for example personal care household chores)

1 2 3 4 5

K11 Spent time doing things that you enjoy

1 2 3 4 5

K12 Spent time doing things that you find personally meaningful

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 14 of 23

Participant ID

SECTION 3L

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

L1 Your physical health 1 2 3 4 5

L2 Your emotionalmental health 1 2 3 4 5

L3 Your health care 1 2 3 4 5

SECTION 4 SOCIAL RELATIONSHIPS

In this next section you will be asked about your romantic relationship involvement

SECTION 4M

ADMINISTRATOR ASK OF EVERYONE

M1 What is your current marital status

Never married Married - first and only marriage Married - second or later marriage Separated Divorced Widowed

ADMINISTRATOR ASK OF THOSE WHO DID NOT INDICATE MARRIED IN M1

M2 Are you currently in a romantic relationship Currently in a relationship and living as a couple Currently in a relationship but not living as a couple Not currently in a relationship

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 15 of 23

Participant ID

M3 How long have you been married or in your current relationship years months

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT MARRIED ON M1 AND NOT IN A RELATIONSHIP ON M2

M4 Which of the following is true with respect to your romantic relationship status I would like to be in a relationship I prefer not to be in a relationship at this time

SECTION 4N

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Over the last 3 months how often have you done the following in your romantic relationship

Never Rarely Sometimes Often Most

or all of the time

N1 Provided your significant other with the emotional support they sought

1 2 3 4 5

N2 Shared your intimate thoughts and feelings

1 2 3 4 5

N3 Done your fair share of day-to-day tasks (for example grocery shopping errands planning activities)

1 2 3 4 5

N4 Initiated leisure time activities that both you and your signifcan t other enjoy

1 2 3 4 5

N5 Made ef ort to work through disagreements respectfully

1 2 3 4 5

N6 Expressed interest andor willingness to engage in regular sexual or physical intimacy

1 2 3 4 5

SECTION 4O

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 16 of 23

Participant ID

Everybody has aspects of their relationship that make them more or less happy Over the last 3 months how satisfied have you been with your significant otherrsquos contribution to the following aspects of your romantic relationship

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

O1Emotional closeness (for example sharing personal thoughts and feelings)

1 2 3 4 5

O2Companionship (for example doing enjoyable activities together)

1 2 3 4 5

O3Sexual and physical intimacy (for example holding hands or having sex)

1 2 3 4 5

O4 Intellectual connection (for example having many things to talk about)

1 2 3 4 5

O5Security (for example being able to trust and depend on partner)

1 2 3 4 5

O6Division of day-to-day tasks (for example your partnerrsquos contribution to chores and planning activities)

1 2 3 4 5

In this next section you will be asked about your parenting experiences

SECTION 4P

P1 Are you a parent or have you served in a parenting role during the past three months Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P2 Do you have children who are age 18 or younger Yes No

Well-Being Inventory (05 August 2019) National Center for PTSD Page 17 of 23

Participant ID

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P3 How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities) Enter a number on each line write 0 if you do not have any children in that age category

Number of Children

Under 5 years old

Age 5 through 12 years old

Age 13 through 18 years old

Age 19 through 26

27 years +

ADMINISTRATOR ASK OF THOSE WHO DO NOT INDICATE HAVING CHILDREN IN P1

P4 Which of the following is true with respect to your parenting status I would like to be a parent now I prefer not to be a parent at this time

SECTION 4Q

ADMINISTRATOR ASK OF ALL THOSE WHO HAVE CHILDREN UNDER 18 IN P2

Please answer the following questions with regard to children 18 or under for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 18 of 23

Participant ID

All parents have strengths and weaknesses Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

Q1Provided a healthy environment for your child(ren) (for example preparing healthy meals caring for their health keeping them safe)

1 2 3 4 5

Q2Been a good example for your child(ren) (for example being respectful during disagreements with others taking good care of your own health)

1 2 3 4 5

Q3Been actively involved in your child(ren)rsquos activities (for example regularly attending sporting and school events giving your full attention during time together)

1 2 3 4 5

Q4Met your child(ren)rsquos needs for physical affection and emotional support (for example giving them hugs being sympathetic to their problems)

1 2 3 4 5

Q5Been able to successfully manage your child(ren)rsquos unique challenges (for example efectively disciplining children)

1 2 3 4 5

SECTION 4R

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

Please answer the following questions with regard to ALL children for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 19 of 23

Participant ID

Parenting can be both rewarding and challenging How satisfed have you been with the following aspects of your parenting experiences over the last 3 months

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

R1 How close you are with your child(ren)

1 2 3 4 5

R2 How much enjoyment you get from parenting

1 2 3 4 5

R3 How your child(ren) are doing in life 1 2 3 4 5

SECTION 4S

ADMINISTRATOR ASK OF EVERYONE

In this next section you will be asked about your experiences in your broader community as well as your relationships with relatives and friends

Over the last 3 months have you regularly done the following

No Yes

S1 Participated in a religious or spiritual community

0 1

S2 Volunteered for a charity political group or other local organization (for example a service organization a political campaign)

0 1

S3 Participated in a community group that shares similar hobbies (for example a sports team a book club)

0 1

S4 Participated in a community group with shared background characteristics (for example a Veterans organization momrsquos group)

0 1

Well-Being Inventory (05 August 2019) National Center for PTSD Page 20 of 23

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
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      606. Text Field 1
Page 7: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Participant ID

Over the last 3 months please indicate how often

Never Rarely Sometimes Often Most

or all of the time

B3 You maintained positive relationships with others in your work setting (for example avoiding confict when possible being patient with coworkers)

1 2 3 4 5

B4 The quality of your work was excellent

1 2 3 4 5

SECTION 1C

ADMINISTRATOR ASK OF THOSE WHO INDICATE WORKING FOR PAY IN A1

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

C1 Your pay and benefits 1 2 3 4 5

C2 Your work environment (for example people you work with work setting)

1 2 3 4 5

ADMINISTRATOR ASK OF THOSE WHO INDICATE WORKING FOR PAY VOLUNTEERING OR CAREGIVINGHOMEMAKING IN A1ampA8

Please answer the next questions with respect to the PRIMARY WORK you have done over the last 3 months For fulltime homemakers andor unpaid caregivers please note that meal preparation household maintenance andor child-rearing are considered your work For volunteers volunteer work is considered your work

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

C3 The kind of work you do 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 5 of 23

Participant ID

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

C4 How much your work contributions are valued

1 2 3 4 5

C5 Your ability to advance your vocational goals in your current role

1 2 3 4 5

C6 Your ability to apply your skills and knowledge to your work

1 2 3 4 5

SECTION 1D

In this next section you will be asked about your educational and training experiences

D1 Are you currently pursuing additional education or attending a trade or technicalvocational school (excluding on-the-job training)

Yes full-time (12 or more credits of coursework if in university setting) Yes part-time (less than 12 credits of coursework if in university setting) No

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

D2 What type of additional education or training are you pursuing High school diploma GED Technicalvocational training (for example carpentry computer programming medical technician training) Taking undergraduate courses but not enrolled in an undergraduate program Associatersquos degree (for example AA AS) Bachelorrsquos degree (for example BA BS) Taking graduate courses but not enrolled in a graduate program Masterrsquos degree (for example MA MS MEng MEd MSW MBA) Doctorate degree (for example PhD EdD) Professional degree beyond a bachelorrsquos degree (for example MD DDS DVM LLB JD)

D3 Which of the following best describes your primary feld of study in y our current education or training

Arts and humanities (for example English art history journalism) Biological sciences (for example biology environmental science) Business (for example accounting fnance)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 6 of 23

Participant ID

Education (for example elementary education special education) Computer-related (for example computer science information technology) Engineering (for example chemical or mechanical engineering) Physical science (for example chemistry statistics) Health science (for example nursing veterinary health technology) Social science (for example social work psychology) Technicalvocational training (please specify) Other (please specify)

ADMINISTRATOR ASK OF EVERYONE

D4 What is the highest degree or level of education you have completed Less than high school Some high school but no diploma or GED High school diploma GED Post-high school vocational or technical training Some college credit no degree Associatersquos degree (for example AA AS) Bachelorrsquos degree (for example BA BS) Masterrsquos degree (for example MA MS MEng MEd MSW MBA) Doctorate degree (for example PhD EdD) Professional degree beyond a bachelorrsquos degree (for example MD DDS DVM LLB JD)

SECTION 1E

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

Over the last 3 months of your education or training please indicate how often

Never Rarely Sometimes Often Most

or all of the time

E1 You completed all required courseworktraining activities

1 2 3 4 5

E2 You went above and beyond in your educational activities (for example completing assignments ahead of schedule participating in educational activities outside of class)

1 2 3 4 5

E3 You did your part to create a positive learning environment (for example contributing to discussions showing appreciation for othersrsquo viewpoints)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 7 of 23

Participant ID

Over the last 3 months of your education or training please indicate how often

Never Rarely Sometimes Often Most

or all of the time

E4 The quality of your coursework training activities was excellent

1 2 3 4 5

SECTION 1F

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

Over the last 3 months of your education or training how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

F1 The quality of your education or training experience

1 2 3 4 5

F2 The extent to which your education or training is advancing your career goals

1 2 3 4 5

F3 Your learning environment (for example teachers and other students educational setting)

1 2 3 4 5

SECTION 2 FINANCES

In the next section we ask about your fnancial cir cumstances Please remember that all information you provide is completely confden tial and will be used to better understand your fnancial w ell-being Also if you are not sure how to answer some of these questions please provide your best guess

In this set of questions your household refers to you other earners who share the majority of expenses and those who depend on this income (for example children or elders)

SECTION 2G

ADMINISTRATOR ASK OF EVERYONE

G1 Are you able to pay for all necessary expenses each month such as mortgagerent debt payments and groceries

Well-Being Inventory (05 August 2019) National Center for PTSD Page 8 of 23

Participant ID

Yes No

G2 Does your household have at least 3 months of your typical income set aside in case of an unexpected fnancial ev ent

Yes No

G3 Does your household have the insurance coverage you andor your family would need if an unexpected financial event were to occur (for example disability insurance property insurance and or life insurance)

Yes No

G4 Has your household begun to set aside money for retirement Yes No

G5 Is your household more than one month behind on your debt payments (for example mortgage or credit card)

No my household is not more than one month behind in debt payments Yes my household is over one month behind in debt payments Not applicable - my household does not have any debt

G6 Are you currently concerned that you will lose your housing and be unable to find stable alternative housing

Yes No

ADMINISTRATOR ASK OF EVERYONE

G7

G8

How many people are supported by your HOUSEHOLD income including yourself your significant other (if you have one) and anyone else partially or fully supported by this income whether or not they live with you

What is your current living situation Rent an apartment house or room Own an apartment or house Live with a friend or relative and not paying rent Live in a dormitory at school Live in a medical or assisted living facility such as a hospital or rehab center Live in transitional housing (for example a halfway house) Live in a car on the street or in a homeless shelter

Well-Being Inventory (05 August 2019) National Center for PTSD Page 9 of 23

Participant ID

Somewhere else (fll-in

ADMINISTRATOR ASK OF THOSE WHO INDICATED THEY WORK FOR PAY IN A1

G9 Please provide your expected annual SALARY before taxes are taken out If you do not know your salary please indicate how much you expect to earn per hour (before taxes) If you do not know the answer please make your best guess

ANNUAL SALARY (before taxes)

-OR-

HOURLY PAY RATE (before taxes)

ADMINISTRATOR ASK OF EVERYONE

G10 Please provide an estimate of your HOUSEHOLDrsquoS yearly income before taxes are taken out Include all sources of income including salary as well as any disability payments real estate income and any other sources of income from all earners in your household If you do not have other sources of income and you are the only earner in your household this may be the same as your salary If you do not know the answer please make your best guess

$

ADMINISTRATOR ASK OF EVERYONE

G11 Approximately how much money does your household have readily available (for example in cash and savings) to cover a financial emergency such as loss of a job If you do not know the answer make your best guess

$

G12 Approximately how much does your HOUSEHOLD pay towards debt and housing expenses PER MONTH (for example mortgagerent bills credit card debt student loans etc)

$

ADMINISTRATOR ASK OF EVERYONE

SECTION 2H

Well-Being Inventory (05 August 2019) National Center for PTSD Page 10 of 22

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most or all of the time

H1 Followed a budget 1 2 3 4 5

H2 Compared prices when purchasing a product or service

1 2 3 4 5

H3 Kept a written or electronic record of your spending

1 2 3 4 5

H4 Been late in paying a bill 1 2 3 4 5

H5 Had credit card debt that you did not pay of each mon th

1 2 3 4 5

H6 Spent more than you could afford on clothing entertainment and other extras

1 2 3 4 5

H7 Contributed part of each paycheck (or other income) to a retirement account such as a 401k or IRA

1 2 3 4 5

H8 Contributed part of each paycheck (or other income) to a personal savings account

1 2 3 4 5

SECTION 2I

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I1 Your ability to pay for necessities 1 2 3 4 5

I2 Your ability to afford extras (for example vacation dinner out)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 11 of 22

Participant ID

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I3 The amount of savings you have 1 2 3 4 5

I4 The amount of debt you have 1 2 3 4 5

SECTION 3 CURRENT HEALTH

In this next section you will be asked about your current physical and emotionalmental health

SECTION 3J

ADMINISTRATOR ASK OF EVERYONE

J1 Do you have an ongoing physical health condition illness or disability (for example high blood pressure pain)

Yes No

J2 Do you have an ongoing mentalemotional health condition illness or disability (for example depression anxiety)

Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE A PHYSICAL HEALTH PROBLEM IN J1 OR A MENTAL HEALTH PROBLEM IN J2

J3 What ongoing physical or mentalemotional health conditions illnesses or disabilities do you have Mark all that apply

High blood pressure or other heart problem High cholesterol Diabetes requiring insulin other medication or special diet Obesity Sleep problem or disorder Chronic pain or pain related disorder (for example knee back migraines)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 12 of 23

Participant ID

Arthritis A hearing condition that is not correctable Alcohol or drug (including prescription drugs) abusedependence Posttraumatic stress disorder Depression Anxiety disorder (for example panic disorder generalized anxiety disorder)Other chronic physical or mental health problem 1 (please specify) Other chronic physical or mental health problem 2 (please specify) Other chronic physical or mental health problem 3 (please specify)

ADMINISTRATOR ASK OF EVERYONE

J4 Do you have healthcare coverage (for example employer-provided health insurance Medicaid) Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATED THAT THEY HAVE HEALTHCARE COVERAGE IN J4

J5 Which of the following best describe your main sources of healthcare coverage Employer-provided health insurance (could be from your current or former employer a family memberrsquos current or former employer or a union) A plan you purchased through a healthcare exchange (for example Healthcaregov State exchange Obamacare etc) TRICARE VA Medicaid Medicare Other government assisted health plan Something else (please specify)

SECTION 3K

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K1 Eaten a generally healthy diet (for example low fat limited sugar adequate servings of fruits and vegetables)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 13 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K2 Gotten at least 2 hours and 30 minutes of moderate physical activity OR 1 hour and 15 minutes of vigorous activity each week

1 2 3 4 5

K3 Done muscle strengthening exercises at least two days per week

1 2 3 4 5

K4 Gotten quality sleep 1 2 3 4 5

K5 Had sexual intercourse without a condom with more than one person or with a person you did not know

1 2 3 4 5

K6 Used tobacco andor nicotine products (for example cigarettes cigars vape)

1 2 3 4 5

K7 Used alcohol in a way that put your health at risk (for example blacking out driving drunk)

1 2 3 4 5

K8 Used drugs (including prescription drugs) in a way that put your health at risk (for example losing memory or consciousness driving under the infuence)

1 2 3 4 5

K9 Completed recommended medical care (for example physical exams)

1 2 3 4 5

K10 Maintained personal cleanliness (for example personal care household chores)

1 2 3 4 5

K11 Spent time doing things that you enjoy

1 2 3 4 5

K12 Spent time doing things that you find personally meaningful

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 14 of 23

Participant ID

SECTION 3L

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

L1 Your physical health 1 2 3 4 5

L2 Your emotionalmental health 1 2 3 4 5

L3 Your health care 1 2 3 4 5

SECTION 4 SOCIAL RELATIONSHIPS

In this next section you will be asked about your romantic relationship involvement

SECTION 4M

ADMINISTRATOR ASK OF EVERYONE

M1 What is your current marital status

Never married Married - first and only marriage Married - second or later marriage Separated Divorced Widowed

ADMINISTRATOR ASK OF THOSE WHO DID NOT INDICATE MARRIED IN M1

M2 Are you currently in a romantic relationship Currently in a relationship and living as a couple Currently in a relationship but not living as a couple Not currently in a relationship

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 15 of 23

Participant ID

M3 How long have you been married or in your current relationship years months

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT MARRIED ON M1 AND NOT IN A RELATIONSHIP ON M2

M4 Which of the following is true with respect to your romantic relationship status I would like to be in a relationship I prefer not to be in a relationship at this time

SECTION 4N

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Over the last 3 months how often have you done the following in your romantic relationship

Never Rarely Sometimes Often Most

or all of the time

N1 Provided your significant other with the emotional support they sought

1 2 3 4 5

N2 Shared your intimate thoughts and feelings

1 2 3 4 5

N3 Done your fair share of day-to-day tasks (for example grocery shopping errands planning activities)

1 2 3 4 5

N4 Initiated leisure time activities that both you and your signifcan t other enjoy

1 2 3 4 5

N5 Made ef ort to work through disagreements respectfully

1 2 3 4 5

N6 Expressed interest andor willingness to engage in regular sexual or physical intimacy

1 2 3 4 5

SECTION 4O

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 16 of 23

Participant ID

Everybody has aspects of their relationship that make them more or less happy Over the last 3 months how satisfied have you been with your significant otherrsquos contribution to the following aspects of your romantic relationship

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

O1Emotional closeness (for example sharing personal thoughts and feelings)

1 2 3 4 5

O2Companionship (for example doing enjoyable activities together)

1 2 3 4 5

O3Sexual and physical intimacy (for example holding hands or having sex)

1 2 3 4 5

O4 Intellectual connection (for example having many things to talk about)

1 2 3 4 5

O5Security (for example being able to trust and depend on partner)

1 2 3 4 5

O6Division of day-to-day tasks (for example your partnerrsquos contribution to chores and planning activities)

1 2 3 4 5

In this next section you will be asked about your parenting experiences

SECTION 4P

P1 Are you a parent or have you served in a parenting role during the past three months Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P2 Do you have children who are age 18 or younger Yes No

Well-Being Inventory (05 August 2019) National Center for PTSD Page 17 of 23

Participant ID

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P3 How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities) Enter a number on each line write 0 if you do not have any children in that age category

Number of Children

Under 5 years old

Age 5 through 12 years old

Age 13 through 18 years old

Age 19 through 26

27 years +

ADMINISTRATOR ASK OF THOSE WHO DO NOT INDICATE HAVING CHILDREN IN P1

P4 Which of the following is true with respect to your parenting status I would like to be a parent now I prefer not to be a parent at this time

SECTION 4Q

ADMINISTRATOR ASK OF ALL THOSE WHO HAVE CHILDREN UNDER 18 IN P2

Please answer the following questions with regard to children 18 or under for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 18 of 23

Participant ID

All parents have strengths and weaknesses Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

Q1Provided a healthy environment for your child(ren) (for example preparing healthy meals caring for their health keeping them safe)

1 2 3 4 5

Q2Been a good example for your child(ren) (for example being respectful during disagreements with others taking good care of your own health)

1 2 3 4 5

Q3Been actively involved in your child(ren)rsquos activities (for example regularly attending sporting and school events giving your full attention during time together)

1 2 3 4 5

Q4Met your child(ren)rsquos needs for physical affection and emotional support (for example giving them hugs being sympathetic to their problems)

1 2 3 4 5

Q5Been able to successfully manage your child(ren)rsquos unique challenges (for example efectively disciplining children)

1 2 3 4 5

SECTION 4R

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

Please answer the following questions with regard to ALL children for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 19 of 23

Participant ID

Parenting can be both rewarding and challenging How satisfed have you been with the following aspects of your parenting experiences over the last 3 months

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

R1 How close you are with your child(ren)

1 2 3 4 5

R2 How much enjoyment you get from parenting

1 2 3 4 5

R3 How your child(ren) are doing in life 1 2 3 4 5

SECTION 4S

ADMINISTRATOR ASK OF EVERYONE

In this next section you will be asked about your experiences in your broader community as well as your relationships with relatives and friends

Over the last 3 months have you regularly done the following

No Yes

S1 Participated in a religious or spiritual community

0 1

S2 Volunteered for a charity political group or other local organization (for example a service organization a political campaign)

0 1

S3 Participated in a community group that shares similar hobbies (for example a sports team a book club)

0 1

S4 Participated in a community group with shared background characteristics (for example a Veterans organization momrsquos group)

0 1

Well-Being Inventory (05 August 2019) National Center for PTSD Page 20 of 23

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
      1. A1-1 Off
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      86. Other7
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      606. Text Field 1
Page 8: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Participant ID

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

C4 How much your work contributions are valued

1 2 3 4 5

C5 Your ability to advance your vocational goals in your current role

1 2 3 4 5

C6 Your ability to apply your skills and knowledge to your work

1 2 3 4 5

SECTION 1D

In this next section you will be asked about your educational and training experiences

D1 Are you currently pursuing additional education or attending a trade or technicalvocational school (excluding on-the-job training)

Yes full-time (12 or more credits of coursework if in university setting) Yes part-time (less than 12 credits of coursework if in university setting) No

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

D2 What type of additional education or training are you pursuing High school diploma GED Technicalvocational training (for example carpentry computer programming medical technician training) Taking undergraduate courses but not enrolled in an undergraduate program Associatersquos degree (for example AA AS) Bachelorrsquos degree (for example BA BS) Taking graduate courses but not enrolled in a graduate program Masterrsquos degree (for example MA MS MEng MEd MSW MBA) Doctorate degree (for example PhD EdD) Professional degree beyond a bachelorrsquos degree (for example MD DDS DVM LLB JD)

D3 Which of the following best describes your primary feld of study in y our current education or training

Arts and humanities (for example English art history journalism) Biological sciences (for example biology environmental science) Business (for example accounting fnance)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 6 of 23

Participant ID

Education (for example elementary education special education) Computer-related (for example computer science information technology) Engineering (for example chemical or mechanical engineering) Physical science (for example chemistry statistics) Health science (for example nursing veterinary health technology) Social science (for example social work psychology) Technicalvocational training (please specify) Other (please specify)

ADMINISTRATOR ASK OF EVERYONE

D4 What is the highest degree or level of education you have completed Less than high school Some high school but no diploma or GED High school diploma GED Post-high school vocational or technical training Some college credit no degree Associatersquos degree (for example AA AS) Bachelorrsquos degree (for example BA BS) Masterrsquos degree (for example MA MS MEng MEd MSW MBA) Doctorate degree (for example PhD EdD) Professional degree beyond a bachelorrsquos degree (for example MD DDS DVM LLB JD)

SECTION 1E

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

Over the last 3 months of your education or training please indicate how often

Never Rarely Sometimes Often Most

or all of the time

E1 You completed all required courseworktraining activities

1 2 3 4 5

E2 You went above and beyond in your educational activities (for example completing assignments ahead of schedule participating in educational activities outside of class)

1 2 3 4 5

E3 You did your part to create a positive learning environment (for example contributing to discussions showing appreciation for othersrsquo viewpoints)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 7 of 23

Participant ID

Over the last 3 months of your education or training please indicate how often

Never Rarely Sometimes Often Most

or all of the time

E4 The quality of your coursework training activities was excellent

1 2 3 4 5

SECTION 1F

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

Over the last 3 months of your education or training how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

F1 The quality of your education or training experience

1 2 3 4 5

F2 The extent to which your education or training is advancing your career goals

1 2 3 4 5

F3 Your learning environment (for example teachers and other students educational setting)

1 2 3 4 5

SECTION 2 FINANCES

In the next section we ask about your fnancial cir cumstances Please remember that all information you provide is completely confden tial and will be used to better understand your fnancial w ell-being Also if you are not sure how to answer some of these questions please provide your best guess

In this set of questions your household refers to you other earners who share the majority of expenses and those who depend on this income (for example children or elders)

SECTION 2G

ADMINISTRATOR ASK OF EVERYONE

G1 Are you able to pay for all necessary expenses each month such as mortgagerent debt payments and groceries

Well-Being Inventory (05 August 2019) National Center for PTSD Page 8 of 23

Participant ID

Yes No

G2 Does your household have at least 3 months of your typical income set aside in case of an unexpected fnancial ev ent

Yes No

G3 Does your household have the insurance coverage you andor your family would need if an unexpected financial event were to occur (for example disability insurance property insurance and or life insurance)

Yes No

G4 Has your household begun to set aside money for retirement Yes No

G5 Is your household more than one month behind on your debt payments (for example mortgage or credit card)

No my household is not more than one month behind in debt payments Yes my household is over one month behind in debt payments Not applicable - my household does not have any debt

G6 Are you currently concerned that you will lose your housing and be unable to find stable alternative housing

Yes No

ADMINISTRATOR ASK OF EVERYONE

G7

G8

How many people are supported by your HOUSEHOLD income including yourself your significant other (if you have one) and anyone else partially or fully supported by this income whether or not they live with you

What is your current living situation Rent an apartment house or room Own an apartment or house Live with a friend or relative and not paying rent Live in a dormitory at school Live in a medical or assisted living facility such as a hospital or rehab center Live in transitional housing (for example a halfway house) Live in a car on the street or in a homeless shelter

Well-Being Inventory (05 August 2019) National Center for PTSD Page 9 of 23

Participant ID

Somewhere else (fll-in

ADMINISTRATOR ASK OF THOSE WHO INDICATED THEY WORK FOR PAY IN A1

G9 Please provide your expected annual SALARY before taxes are taken out If you do not know your salary please indicate how much you expect to earn per hour (before taxes) If you do not know the answer please make your best guess

ANNUAL SALARY (before taxes)

-OR-

HOURLY PAY RATE (before taxes)

ADMINISTRATOR ASK OF EVERYONE

G10 Please provide an estimate of your HOUSEHOLDrsquoS yearly income before taxes are taken out Include all sources of income including salary as well as any disability payments real estate income and any other sources of income from all earners in your household If you do not have other sources of income and you are the only earner in your household this may be the same as your salary If you do not know the answer please make your best guess

$

ADMINISTRATOR ASK OF EVERYONE

G11 Approximately how much money does your household have readily available (for example in cash and savings) to cover a financial emergency such as loss of a job If you do not know the answer make your best guess

$

G12 Approximately how much does your HOUSEHOLD pay towards debt and housing expenses PER MONTH (for example mortgagerent bills credit card debt student loans etc)

$

ADMINISTRATOR ASK OF EVERYONE

SECTION 2H

Well-Being Inventory (05 August 2019) National Center for PTSD Page 10 of 22

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most or all of the time

H1 Followed a budget 1 2 3 4 5

H2 Compared prices when purchasing a product or service

1 2 3 4 5

H3 Kept a written or electronic record of your spending

1 2 3 4 5

H4 Been late in paying a bill 1 2 3 4 5

H5 Had credit card debt that you did not pay of each mon th

1 2 3 4 5

H6 Spent more than you could afford on clothing entertainment and other extras

1 2 3 4 5

H7 Contributed part of each paycheck (or other income) to a retirement account such as a 401k or IRA

1 2 3 4 5

H8 Contributed part of each paycheck (or other income) to a personal savings account

1 2 3 4 5

SECTION 2I

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I1 Your ability to pay for necessities 1 2 3 4 5

I2 Your ability to afford extras (for example vacation dinner out)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 11 of 22

Participant ID

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I3 The amount of savings you have 1 2 3 4 5

I4 The amount of debt you have 1 2 3 4 5

SECTION 3 CURRENT HEALTH

In this next section you will be asked about your current physical and emotionalmental health

SECTION 3J

ADMINISTRATOR ASK OF EVERYONE

J1 Do you have an ongoing physical health condition illness or disability (for example high blood pressure pain)

Yes No

J2 Do you have an ongoing mentalemotional health condition illness or disability (for example depression anxiety)

Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE A PHYSICAL HEALTH PROBLEM IN J1 OR A MENTAL HEALTH PROBLEM IN J2

J3 What ongoing physical or mentalemotional health conditions illnesses or disabilities do you have Mark all that apply

High blood pressure or other heart problem High cholesterol Diabetes requiring insulin other medication or special diet Obesity Sleep problem or disorder Chronic pain or pain related disorder (for example knee back migraines)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 12 of 23

Participant ID

Arthritis A hearing condition that is not correctable Alcohol or drug (including prescription drugs) abusedependence Posttraumatic stress disorder Depression Anxiety disorder (for example panic disorder generalized anxiety disorder)Other chronic physical or mental health problem 1 (please specify) Other chronic physical or mental health problem 2 (please specify) Other chronic physical or mental health problem 3 (please specify)

ADMINISTRATOR ASK OF EVERYONE

J4 Do you have healthcare coverage (for example employer-provided health insurance Medicaid) Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATED THAT THEY HAVE HEALTHCARE COVERAGE IN J4

J5 Which of the following best describe your main sources of healthcare coverage Employer-provided health insurance (could be from your current or former employer a family memberrsquos current or former employer or a union) A plan you purchased through a healthcare exchange (for example Healthcaregov State exchange Obamacare etc) TRICARE VA Medicaid Medicare Other government assisted health plan Something else (please specify)

SECTION 3K

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K1 Eaten a generally healthy diet (for example low fat limited sugar adequate servings of fruits and vegetables)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 13 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K2 Gotten at least 2 hours and 30 minutes of moderate physical activity OR 1 hour and 15 minutes of vigorous activity each week

1 2 3 4 5

K3 Done muscle strengthening exercises at least two days per week

1 2 3 4 5

K4 Gotten quality sleep 1 2 3 4 5

K5 Had sexual intercourse without a condom with more than one person or with a person you did not know

1 2 3 4 5

K6 Used tobacco andor nicotine products (for example cigarettes cigars vape)

1 2 3 4 5

K7 Used alcohol in a way that put your health at risk (for example blacking out driving drunk)

1 2 3 4 5

K8 Used drugs (including prescription drugs) in a way that put your health at risk (for example losing memory or consciousness driving under the infuence)

1 2 3 4 5

K9 Completed recommended medical care (for example physical exams)

1 2 3 4 5

K10 Maintained personal cleanliness (for example personal care household chores)

1 2 3 4 5

K11 Spent time doing things that you enjoy

1 2 3 4 5

K12 Spent time doing things that you find personally meaningful

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 14 of 23

Participant ID

SECTION 3L

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

L1 Your physical health 1 2 3 4 5

L2 Your emotionalmental health 1 2 3 4 5

L3 Your health care 1 2 3 4 5

SECTION 4 SOCIAL RELATIONSHIPS

In this next section you will be asked about your romantic relationship involvement

SECTION 4M

ADMINISTRATOR ASK OF EVERYONE

M1 What is your current marital status

Never married Married - first and only marriage Married - second or later marriage Separated Divorced Widowed

ADMINISTRATOR ASK OF THOSE WHO DID NOT INDICATE MARRIED IN M1

M2 Are you currently in a romantic relationship Currently in a relationship and living as a couple Currently in a relationship but not living as a couple Not currently in a relationship

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 15 of 23

Participant ID

M3 How long have you been married or in your current relationship years months

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT MARRIED ON M1 AND NOT IN A RELATIONSHIP ON M2

M4 Which of the following is true with respect to your romantic relationship status I would like to be in a relationship I prefer not to be in a relationship at this time

SECTION 4N

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Over the last 3 months how often have you done the following in your romantic relationship

Never Rarely Sometimes Often Most

or all of the time

N1 Provided your significant other with the emotional support they sought

1 2 3 4 5

N2 Shared your intimate thoughts and feelings

1 2 3 4 5

N3 Done your fair share of day-to-day tasks (for example grocery shopping errands planning activities)

1 2 3 4 5

N4 Initiated leisure time activities that both you and your signifcan t other enjoy

1 2 3 4 5

N5 Made ef ort to work through disagreements respectfully

1 2 3 4 5

N6 Expressed interest andor willingness to engage in regular sexual or physical intimacy

1 2 3 4 5

SECTION 4O

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 16 of 23

Participant ID

Everybody has aspects of their relationship that make them more or less happy Over the last 3 months how satisfied have you been with your significant otherrsquos contribution to the following aspects of your romantic relationship

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

O1Emotional closeness (for example sharing personal thoughts and feelings)

1 2 3 4 5

O2Companionship (for example doing enjoyable activities together)

1 2 3 4 5

O3Sexual and physical intimacy (for example holding hands or having sex)

1 2 3 4 5

O4 Intellectual connection (for example having many things to talk about)

1 2 3 4 5

O5Security (for example being able to trust and depend on partner)

1 2 3 4 5

O6Division of day-to-day tasks (for example your partnerrsquos contribution to chores and planning activities)

1 2 3 4 5

In this next section you will be asked about your parenting experiences

SECTION 4P

P1 Are you a parent or have you served in a parenting role during the past three months Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P2 Do you have children who are age 18 or younger Yes No

Well-Being Inventory (05 August 2019) National Center for PTSD Page 17 of 23

Participant ID

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P3 How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities) Enter a number on each line write 0 if you do not have any children in that age category

Number of Children

Under 5 years old

Age 5 through 12 years old

Age 13 through 18 years old

Age 19 through 26

27 years +

ADMINISTRATOR ASK OF THOSE WHO DO NOT INDICATE HAVING CHILDREN IN P1

P4 Which of the following is true with respect to your parenting status I would like to be a parent now I prefer not to be a parent at this time

SECTION 4Q

ADMINISTRATOR ASK OF ALL THOSE WHO HAVE CHILDREN UNDER 18 IN P2

Please answer the following questions with regard to children 18 or under for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 18 of 23

Participant ID

All parents have strengths and weaknesses Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

Q1Provided a healthy environment for your child(ren) (for example preparing healthy meals caring for their health keeping them safe)

1 2 3 4 5

Q2Been a good example for your child(ren) (for example being respectful during disagreements with others taking good care of your own health)

1 2 3 4 5

Q3Been actively involved in your child(ren)rsquos activities (for example regularly attending sporting and school events giving your full attention during time together)

1 2 3 4 5

Q4Met your child(ren)rsquos needs for physical affection and emotional support (for example giving them hugs being sympathetic to their problems)

1 2 3 4 5

Q5Been able to successfully manage your child(ren)rsquos unique challenges (for example efectively disciplining children)

1 2 3 4 5

SECTION 4R

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

Please answer the following questions with regard to ALL children for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 19 of 23

Participant ID

Parenting can be both rewarding and challenging How satisfed have you been with the following aspects of your parenting experiences over the last 3 months

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

R1 How close you are with your child(ren)

1 2 3 4 5

R2 How much enjoyment you get from parenting

1 2 3 4 5

R3 How your child(ren) are doing in life 1 2 3 4 5

SECTION 4S

ADMINISTRATOR ASK OF EVERYONE

In this next section you will be asked about your experiences in your broader community as well as your relationships with relatives and friends

Over the last 3 months have you regularly done the following

No Yes

S1 Participated in a religious or spiritual community

0 1

S2 Volunteered for a charity political group or other local organization (for example a service organization a political campaign)

0 1

S3 Participated in a community group that shares similar hobbies (for example a sports team a book club)

0 1

S4 Participated in a community group with shared background characteristics (for example a Veterans organization momrsquos group)

0 1

Well-Being Inventory (05 August 2019) National Center for PTSD Page 20 of 23

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
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      606. Text Field 1
Page 9: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Participant ID

Education (for example elementary education special education) Computer-related (for example computer science information technology) Engineering (for example chemical or mechanical engineering) Physical science (for example chemistry statistics) Health science (for example nursing veterinary health technology) Social science (for example social work psychology) Technicalvocational training (please specify) Other (please specify)

ADMINISTRATOR ASK OF EVERYONE

D4 What is the highest degree or level of education you have completed Less than high school Some high school but no diploma or GED High school diploma GED Post-high school vocational or technical training Some college credit no degree Associatersquos degree (for example AA AS) Bachelorrsquos degree (for example BA BS) Masterrsquos degree (for example MA MS MEng MEd MSW MBA) Doctorate degree (for example PhD EdD) Professional degree beyond a bachelorrsquos degree (for example MD DDS DVM LLB JD)

SECTION 1E

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

Over the last 3 months of your education or training please indicate how often

Never Rarely Sometimes Often Most

or all of the time

E1 You completed all required courseworktraining activities

1 2 3 4 5

E2 You went above and beyond in your educational activities (for example completing assignments ahead of schedule participating in educational activities outside of class)

1 2 3 4 5

E3 You did your part to create a positive learning environment (for example contributing to discussions showing appreciation for othersrsquo viewpoints)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 7 of 23

Participant ID

Over the last 3 months of your education or training please indicate how often

Never Rarely Sometimes Often Most

or all of the time

E4 The quality of your coursework training activities was excellent

1 2 3 4 5

SECTION 1F

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

Over the last 3 months of your education or training how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

F1 The quality of your education or training experience

1 2 3 4 5

F2 The extent to which your education or training is advancing your career goals

1 2 3 4 5

F3 Your learning environment (for example teachers and other students educational setting)

1 2 3 4 5

SECTION 2 FINANCES

In the next section we ask about your fnancial cir cumstances Please remember that all information you provide is completely confden tial and will be used to better understand your fnancial w ell-being Also if you are not sure how to answer some of these questions please provide your best guess

In this set of questions your household refers to you other earners who share the majority of expenses and those who depend on this income (for example children or elders)

SECTION 2G

ADMINISTRATOR ASK OF EVERYONE

G1 Are you able to pay for all necessary expenses each month such as mortgagerent debt payments and groceries

Well-Being Inventory (05 August 2019) National Center for PTSD Page 8 of 23

Participant ID

Yes No

G2 Does your household have at least 3 months of your typical income set aside in case of an unexpected fnancial ev ent

Yes No

G3 Does your household have the insurance coverage you andor your family would need if an unexpected financial event were to occur (for example disability insurance property insurance and or life insurance)

Yes No

G4 Has your household begun to set aside money for retirement Yes No

G5 Is your household more than one month behind on your debt payments (for example mortgage or credit card)

No my household is not more than one month behind in debt payments Yes my household is over one month behind in debt payments Not applicable - my household does not have any debt

G6 Are you currently concerned that you will lose your housing and be unable to find stable alternative housing

Yes No

ADMINISTRATOR ASK OF EVERYONE

G7

G8

How many people are supported by your HOUSEHOLD income including yourself your significant other (if you have one) and anyone else partially or fully supported by this income whether or not they live with you

What is your current living situation Rent an apartment house or room Own an apartment or house Live with a friend or relative and not paying rent Live in a dormitory at school Live in a medical or assisted living facility such as a hospital or rehab center Live in transitional housing (for example a halfway house) Live in a car on the street or in a homeless shelter

Well-Being Inventory (05 August 2019) National Center for PTSD Page 9 of 23

Participant ID

Somewhere else (fll-in

ADMINISTRATOR ASK OF THOSE WHO INDICATED THEY WORK FOR PAY IN A1

G9 Please provide your expected annual SALARY before taxes are taken out If you do not know your salary please indicate how much you expect to earn per hour (before taxes) If you do not know the answer please make your best guess

ANNUAL SALARY (before taxes)

-OR-

HOURLY PAY RATE (before taxes)

ADMINISTRATOR ASK OF EVERYONE

G10 Please provide an estimate of your HOUSEHOLDrsquoS yearly income before taxes are taken out Include all sources of income including salary as well as any disability payments real estate income and any other sources of income from all earners in your household If you do not have other sources of income and you are the only earner in your household this may be the same as your salary If you do not know the answer please make your best guess

$

ADMINISTRATOR ASK OF EVERYONE

G11 Approximately how much money does your household have readily available (for example in cash and savings) to cover a financial emergency such as loss of a job If you do not know the answer make your best guess

$

G12 Approximately how much does your HOUSEHOLD pay towards debt and housing expenses PER MONTH (for example mortgagerent bills credit card debt student loans etc)

$

ADMINISTRATOR ASK OF EVERYONE

SECTION 2H

Well-Being Inventory (05 August 2019) National Center for PTSD Page 10 of 22

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most or all of the time

H1 Followed a budget 1 2 3 4 5

H2 Compared prices when purchasing a product or service

1 2 3 4 5

H3 Kept a written or electronic record of your spending

1 2 3 4 5

H4 Been late in paying a bill 1 2 3 4 5

H5 Had credit card debt that you did not pay of each mon th

1 2 3 4 5

H6 Spent more than you could afford on clothing entertainment and other extras

1 2 3 4 5

H7 Contributed part of each paycheck (or other income) to a retirement account such as a 401k or IRA

1 2 3 4 5

H8 Contributed part of each paycheck (or other income) to a personal savings account

1 2 3 4 5

SECTION 2I

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I1 Your ability to pay for necessities 1 2 3 4 5

I2 Your ability to afford extras (for example vacation dinner out)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 11 of 22

Participant ID

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I3 The amount of savings you have 1 2 3 4 5

I4 The amount of debt you have 1 2 3 4 5

SECTION 3 CURRENT HEALTH

In this next section you will be asked about your current physical and emotionalmental health

SECTION 3J

ADMINISTRATOR ASK OF EVERYONE

J1 Do you have an ongoing physical health condition illness or disability (for example high blood pressure pain)

Yes No

J2 Do you have an ongoing mentalemotional health condition illness or disability (for example depression anxiety)

Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE A PHYSICAL HEALTH PROBLEM IN J1 OR A MENTAL HEALTH PROBLEM IN J2

J3 What ongoing physical or mentalemotional health conditions illnesses or disabilities do you have Mark all that apply

High blood pressure or other heart problem High cholesterol Diabetes requiring insulin other medication or special diet Obesity Sleep problem or disorder Chronic pain or pain related disorder (for example knee back migraines)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 12 of 23

Participant ID

Arthritis A hearing condition that is not correctable Alcohol or drug (including prescription drugs) abusedependence Posttraumatic stress disorder Depression Anxiety disorder (for example panic disorder generalized anxiety disorder)Other chronic physical or mental health problem 1 (please specify) Other chronic physical or mental health problem 2 (please specify) Other chronic physical or mental health problem 3 (please specify)

ADMINISTRATOR ASK OF EVERYONE

J4 Do you have healthcare coverage (for example employer-provided health insurance Medicaid) Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATED THAT THEY HAVE HEALTHCARE COVERAGE IN J4

J5 Which of the following best describe your main sources of healthcare coverage Employer-provided health insurance (could be from your current or former employer a family memberrsquos current or former employer or a union) A plan you purchased through a healthcare exchange (for example Healthcaregov State exchange Obamacare etc) TRICARE VA Medicaid Medicare Other government assisted health plan Something else (please specify)

SECTION 3K

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K1 Eaten a generally healthy diet (for example low fat limited sugar adequate servings of fruits and vegetables)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 13 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K2 Gotten at least 2 hours and 30 minutes of moderate physical activity OR 1 hour and 15 minutes of vigorous activity each week

1 2 3 4 5

K3 Done muscle strengthening exercises at least two days per week

1 2 3 4 5

K4 Gotten quality sleep 1 2 3 4 5

K5 Had sexual intercourse without a condom with more than one person or with a person you did not know

1 2 3 4 5

K6 Used tobacco andor nicotine products (for example cigarettes cigars vape)

1 2 3 4 5

K7 Used alcohol in a way that put your health at risk (for example blacking out driving drunk)

1 2 3 4 5

K8 Used drugs (including prescription drugs) in a way that put your health at risk (for example losing memory or consciousness driving under the infuence)

1 2 3 4 5

K9 Completed recommended medical care (for example physical exams)

1 2 3 4 5

K10 Maintained personal cleanliness (for example personal care household chores)

1 2 3 4 5

K11 Spent time doing things that you enjoy

1 2 3 4 5

K12 Spent time doing things that you find personally meaningful

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 14 of 23

Participant ID

SECTION 3L

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

L1 Your physical health 1 2 3 4 5

L2 Your emotionalmental health 1 2 3 4 5

L3 Your health care 1 2 3 4 5

SECTION 4 SOCIAL RELATIONSHIPS

In this next section you will be asked about your romantic relationship involvement

SECTION 4M

ADMINISTRATOR ASK OF EVERYONE

M1 What is your current marital status

Never married Married - first and only marriage Married - second or later marriage Separated Divorced Widowed

ADMINISTRATOR ASK OF THOSE WHO DID NOT INDICATE MARRIED IN M1

M2 Are you currently in a romantic relationship Currently in a relationship and living as a couple Currently in a relationship but not living as a couple Not currently in a relationship

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 15 of 23

Participant ID

M3 How long have you been married or in your current relationship years months

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT MARRIED ON M1 AND NOT IN A RELATIONSHIP ON M2

M4 Which of the following is true with respect to your romantic relationship status I would like to be in a relationship I prefer not to be in a relationship at this time

SECTION 4N

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Over the last 3 months how often have you done the following in your romantic relationship

Never Rarely Sometimes Often Most

or all of the time

N1 Provided your significant other with the emotional support they sought

1 2 3 4 5

N2 Shared your intimate thoughts and feelings

1 2 3 4 5

N3 Done your fair share of day-to-day tasks (for example grocery shopping errands planning activities)

1 2 3 4 5

N4 Initiated leisure time activities that both you and your signifcan t other enjoy

1 2 3 4 5

N5 Made ef ort to work through disagreements respectfully

1 2 3 4 5

N6 Expressed interest andor willingness to engage in regular sexual or physical intimacy

1 2 3 4 5

SECTION 4O

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 16 of 23

Participant ID

Everybody has aspects of their relationship that make them more or less happy Over the last 3 months how satisfied have you been with your significant otherrsquos contribution to the following aspects of your romantic relationship

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

O1Emotional closeness (for example sharing personal thoughts and feelings)

1 2 3 4 5

O2Companionship (for example doing enjoyable activities together)

1 2 3 4 5

O3Sexual and physical intimacy (for example holding hands or having sex)

1 2 3 4 5

O4 Intellectual connection (for example having many things to talk about)

1 2 3 4 5

O5Security (for example being able to trust and depend on partner)

1 2 3 4 5

O6Division of day-to-day tasks (for example your partnerrsquos contribution to chores and planning activities)

1 2 3 4 5

In this next section you will be asked about your parenting experiences

SECTION 4P

P1 Are you a parent or have you served in a parenting role during the past three months Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P2 Do you have children who are age 18 or younger Yes No

Well-Being Inventory (05 August 2019) National Center for PTSD Page 17 of 23

Participant ID

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P3 How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities) Enter a number on each line write 0 if you do not have any children in that age category

Number of Children

Under 5 years old

Age 5 through 12 years old

Age 13 through 18 years old

Age 19 through 26

27 years +

ADMINISTRATOR ASK OF THOSE WHO DO NOT INDICATE HAVING CHILDREN IN P1

P4 Which of the following is true with respect to your parenting status I would like to be a parent now I prefer not to be a parent at this time

SECTION 4Q

ADMINISTRATOR ASK OF ALL THOSE WHO HAVE CHILDREN UNDER 18 IN P2

Please answer the following questions with regard to children 18 or under for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 18 of 23

Participant ID

All parents have strengths and weaknesses Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

Q1Provided a healthy environment for your child(ren) (for example preparing healthy meals caring for their health keeping them safe)

1 2 3 4 5

Q2Been a good example for your child(ren) (for example being respectful during disagreements with others taking good care of your own health)

1 2 3 4 5

Q3Been actively involved in your child(ren)rsquos activities (for example regularly attending sporting and school events giving your full attention during time together)

1 2 3 4 5

Q4Met your child(ren)rsquos needs for physical affection and emotional support (for example giving them hugs being sympathetic to their problems)

1 2 3 4 5

Q5Been able to successfully manage your child(ren)rsquos unique challenges (for example efectively disciplining children)

1 2 3 4 5

SECTION 4R

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

Please answer the following questions with regard to ALL children for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 19 of 23

Participant ID

Parenting can be both rewarding and challenging How satisfed have you been with the following aspects of your parenting experiences over the last 3 months

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

R1 How close you are with your child(ren)

1 2 3 4 5

R2 How much enjoyment you get from parenting

1 2 3 4 5

R3 How your child(ren) are doing in life 1 2 3 4 5

SECTION 4S

ADMINISTRATOR ASK OF EVERYONE

In this next section you will be asked about your experiences in your broader community as well as your relationships with relatives and friends

Over the last 3 months have you regularly done the following

No Yes

S1 Participated in a religious or spiritual community

0 1

S2 Volunteered for a charity political group or other local organization (for example a service organization a political campaign)

0 1

S3 Participated in a community group that shares similar hobbies (for example a sports team a book club)

0 1

S4 Participated in a community group with shared background characteristics (for example a Veterans organization momrsquos group)

0 1

Well-Being Inventory (05 August 2019) National Center for PTSD Page 20 of 23

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
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      230. Annual salary
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      480. Children1
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      606. Text Field 1
Page 10: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Participant ID

Over the last 3 months of your education or training please indicate how often

Never Rarely Sometimes Often Most

or all of the time

E4 The quality of your coursework training activities was excellent

1 2 3 4 5

SECTION 1F

ADMINISTRATOR ASK OF THOSE WHO INDICATE THEY ARE A STUDENT IN D1

Over the last 3 months of your education or training how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

F1 The quality of your education or training experience

1 2 3 4 5

F2 The extent to which your education or training is advancing your career goals

1 2 3 4 5

F3 Your learning environment (for example teachers and other students educational setting)

1 2 3 4 5

SECTION 2 FINANCES

In the next section we ask about your fnancial cir cumstances Please remember that all information you provide is completely confden tial and will be used to better understand your fnancial w ell-being Also if you are not sure how to answer some of these questions please provide your best guess

In this set of questions your household refers to you other earners who share the majority of expenses and those who depend on this income (for example children or elders)

SECTION 2G

ADMINISTRATOR ASK OF EVERYONE

G1 Are you able to pay for all necessary expenses each month such as mortgagerent debt payments and groceries

Well-Being Inventory (05 August 2019) National Center for PTSD Page 8 of 23

Participant ID

Yes No

G2 Does your household have at least 3 months of your typical income set aside in case of an unexpected fnancial ev ent

Yes No

G3 Does your household have the insurance coverage you andor your family would need if an unexpected financial event were to occur (for example disability insurance property insurance and or life insurance)

Yes No

G4 Has your household begun to set aside money for retirement Yes No

G5 Is your household more than one month behind on your debt payments (for example mortgage or credit card)

No my household is not more than one month behind in debt payments Yes my household is over one month behind in debt payments Not applicable - my household does not have any debt

G6 Are you currently concerned that you will lose your housing and be unable to find stable alternative housing

Yes No

ADMINISTRATOR ASK OF EVERYONE

G7

G8

How many people are supported by your HOUSEHOLD income including yourself your significant other (if you have one) and anyone else partially or fully supported by this income whether or not they live with you

What is your current living situation Rent an apartment house or room Own an apartment or house Live with a friend or relative and not paying rent Live in a dormitory at school Live in a medical or assisted living facility such as a hospital or rehab center Live in transitional housing (for example a halfway house) Live in a car on the street or in a homeless shelter

Well-Being Inventory (05 August 2019) National Center for PTSD Page 9 of 23

Participant ID

Somewhere else (fll-in

ADMINISTRATOR ASK OF THOSE WHO INDICATED THEY WORK FOR PAY IN A1

G9 Please provide your expected annual SALARY before taxes are taken out If you do not know your salary please indicate how much you expect to earn per hour (before taxes) If you do not know the answer please make your best guess

ANNUAL SALARY (before taxes)

-OR-

HOURLY PAY RATE (before taxes)

ADMINISTRATOR ASK OF EVERYONE

G10 Please provide an estimate of your HOUSEHOLDrsquoS yearly income before taxes are taken out Include all sources of income including salary as well as any disability payments real estate income and any other sources of income from all earners in your household If you do not have other sources of income and you are the only earner in your household this may be the same as your salary If you do not know the answer please make your best guess

$

ADMINISTRATOR ASK OF EVERYONE

G11 Approximately how much money does your household have readily available (for example in cash and savings) to cover a financial emergency such as loss of a job If you do not know the answer make your best guess

$

G12 Approximately how much does your HOUSEHOLD pay towards debt and housing expenses PER MONTH (for example mortgagerent bills credit card debt student loans etc)

$

ADMINISTRATOR ASK OF EVERYONE

SECTION 2H

Well-Being Inventory (05 August 2019) National Center for PTSD Page 10 of 22

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most or all of the time

H1 Followed a budget 1 2 3 4 5

H2 Compared prices when purchasing a product or service

1 2 3 4 5

H3 Kept a written or electronic record of your spending

1 2 3 4 5

H4 Been late in paying a bill 1 2 3 4 5

H5 Had credit card debt that you did not pay of each mon th

1 2 3 4 5

H6 Spent more than you could afford on clothing entertainment and other extras

1 2 3 4 5

H7 Contributed part of each paycheck (or other income) to a retirement account such as a 401k or IRA

1 2 3 4 5

H8 Contributed part of each paycheck (or other income) to a personal savings account

1 2 3 4 5

SECTION 2I

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I1 Your ability to pay for necessities 1 2 3 4 5

I2 Your ability to afford extras (for example vacation dinner out)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 11 of 22

Participant ID

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I3 The amount of savings you have 1 2 3 4 5

I4 The amount of debt you have 1 2 3 4 5

SECTION 3 CURRENT HEALTH

In this next section you will be asked about your current physical and emotionalmental health

SECTION 3J

ADMINISTRATOR ASK OF EVERYONE

J1 Do you have an ongoing physical health condition illness or disability (for example high blood pressure pain)

Yes No

J2 Do you have an ongoing mentalemotional health condition illness or disability (for example depression anxiety)

Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE A PHYSICAL HEALTH PROBLEM IN J1 OR A MENTAL HEALTH PROBLEM IN J2

J3 What ongoing physical or mentalemotional health conditions illnesses or disabilities do you have Mark all that apply

High blood pressure or other heart problem High cholesterol Diabetes requiring insulin other medication or special diet Obesity Sleep problem or disorder Chronic pain or pain related disorder (for example knee back migraines)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 12 of 23

Participant ID

Arthritis A hearing condition that is not correctable Alcohol or drug (including prescription drugs) abusedependence Posttraumatic stress disorder Depression Anxiety disorder (for example panic disorder generalized anxiety disorder)Other chronic physical or mental health problem 1 (please specify) Other chronic physical or mental health problem 2 (please specify) Other chronic physical or mental health problem 3 (please specify)

ADMINISTRATOR ASK OF EVERYONE

J4 Do you have healthcare coverage (for example employer-provided health insurance Medicaid) Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATED THAT THEY HAVE HEALTHCARE COVERAGE IN J4

J5 Which of the following best describe your main sources of healthcare coverage Employer-provided health insurance (could be from your current or former employer a family memberrsquos current or former employer or a union) A plan you purchased through a healthcare exchange (for example Healthcaregov State exchange Obamacare etc) TRICARE VA Medicaid Medicare Other government assisted health plan Something else (please specify)

SECTION 3K

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K1 Eaten a generally healthy diet (for example low fat limited sugar adequate servings of fruits and vegetables)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 13 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K2 Gotten at least 2 hours and 30 minutes of moderate physical activity OR 1 hour and 15 minutes of vigorous activity each week

1 2 3 4 5

K3 Done muscle strengthening exercises at least two days per week

1 2 3 4 5

K4 Gotten quality sleep 1 2 3 4 5

K5 Had sexual intercourse without a condom with more than one person or with a person you did not know

1 2 3 4 5

K6 Used tobacco andor nicotine products (for example cigarettes cigars vape)

1 2 3 4 5

K7 Used alcohol in a way that put your health at risk (for example blacking out driving drunk)

1 2 3 4 5

K8 Used drugs (including prescription drugs) in a way that put your health at risk (for example losing memory or consciousness driving under the infuence)

1 2 3 4 5

K9 Completed recommended medical care (for example physical exams)

1 2 3 4 5

K10 Maintained personal cleanliness (for example personal care household chores)

1 2 3 4 5

K11 Spent time doing things that you enjoy

1 2 3 4 5

K12 Spent time doing things that you find personally meaningful

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 14 of 23

Participant ID

SECTION 3L

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

L1 Your physical health 1 2 3 4 5

L2 Your emotionalmental health 1 2 3 4 5

L3 Your health care 1 2 3 4 5

SECTION 4 SOCIAL RELATIONSHIPS

In this next section you will be asked about your romantic relationship involvement

SECTION 4M

ADMINISTRATOR ASK OF EVERYONE

M1 What is your current marital status

Never married Married - first and only marriage Married - second or later marriage Separated Divorced Widowed

ADMINISTRATOR ASK OF THOSE WHO DID NOT INDICATE MARRIED IN M1

M2 Are you currently in a romantic relationship Currently in a relationship and living as a couple Currently in a relationship but not living as a couple Not currently in a relationship

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 15 of 23

Participant ID

M3 How long have you been married or in your current relationship years months

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT MARRIED ON M1 AND NOT IN A RELATIONSHIP ON M2

M4 Which of the following is true with respect to your romantic relationship status I would like to be in a relationship I prefer not to be in a relationship at this time

SECTION 4N

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Over the last 3 months how often have you done the following in your romantic relationship

Never Rarely Sometimes Often Most

or all of the time

N1 Provided your significant other with the emotional support they sought

1 2 3 4 5

N2 Shared your intimate thoughts and feelings

1 2 3 4 5

N3 Done your fair share of day-to-day tasks (for example grocery shopping errands planning activities)

1 2 3 4 5

N4 Initiated leisure time activities that both you and your signifcan t other enjoy

1 2 3 4 5

N5 Made ef ort to work through disagreements respectfully

1 2 3 4 5

N6 Expressed interest andor willingness to engage in regular sexual or physical intimacy

1 2 3 4 5

SECTION 4O

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 16 of 23

Participant ID

Everybody has aspects of their relationship that make them more or less happy Over the last 3 months how satisfied have you been with your significant otherrsquos contribution to the following aspects of your romantic relationship

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

O1Emotional closeness (for example sharing personal thoughts and feelings)

1 2 3 4 5

O2Companionship (for example doing enjoyable activities together)

1 2 3 4 5

O3Sexual and physical intimacy (for example holding hands or having sex)

1 2 3 4 5

O4 Intellectual connection (for example having many things to talk about)

1 2 3 4 5

O5Security (for example being able to trust and depend on partner)

1 2 3 4 5

O6Division of day-to-day tasks (for example your partnerrsquos contribution to chores and planning activities)

1 2 3 4 5

In this next section you will be asked about your parenting experiences

SECTION 4P

P1 Are you a parent or have you served in a parenting role during the past three months Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P2 Do you have children who are age 18 or younger Yes No

Well-Being Inventory (05 August 2019) National Center for PTSD Page 17 of 23

Participant ID

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P3 How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities) Enter a number on each line write 0 if you do not have any children in that age category

Number of Children

Under 5 years old

Age 5 through 12 years old

Age 13 through 18 years old

Age 19 through 26

27 years +

ADMINISTRATOR ASK OF THOSE WHO DO NOT INDICATE HAVING CHILDREN IN P1

P4 Which of the following is true with respect to your parenting status I would like to be a parent now I prefer not to be a parent at this time

SECTION 4Q

ADMINISTRATOR ASK OF ALL THOSE WHO HAVE CHILDREN UNDER 18 IN P2

Please answer the following questions with regard to children 18 or under for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 18 of 23

Participant ID

All parents have strengths and weaknesses Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

Q1Provided a healthy environment for your child(ren) (for example preparing healthy meals caring for their health keeping them safe)

1 2 3 4 5

Q2Been a good example for your child(ren) (for example being respectful during disagreements with others taking good care of your own health)

1 2 3 4 5

Q3Been actively involved in your child(ren)rsquos activities (for example regularly attending sporting and school events giving your full attention during time together)

1 2 3 4 5

Q4Met your child(ren)rsquos needs for physical affection and emotional support (for example giving them hugs being sympathetic to their problems)

1 2 3 4 5

Q5Been able to successfully manage your child(ren)rsquos unique challenges (for example efectively disciplining children)

1 2 3 4 5

SECTION 4R

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

Please answer the following questions with regard to ALL children for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 19 of 23

Participant ID

Parenting can be both rewarding and challenging How satisfed have you been with the following aspects of your parenting experiences over the last 3 months

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

R1 How close you are with your child(ren)

1 2 3 4 5

R2 How much enjoyment you get from parenting

1 2 3 4 5

R3 How your child(ren) are doing in life 1 2 3 4 5

SECTION 4S

ADMINISTRATOR ASK OF EVERYONE

In this next section you will be asked about your experiences in your broader community as well as your relationships with relatives and friends

Over the last 3 months have you regularly done the following

No Yes

S1 Participated in a religious or spiritual community

0 1

S2 Volunteered for a charity political group or other local organization (for example a service organization a political campaign)

0 1

S3 Participated in a community group that shares similar hobbies (for example a sports team a book club)

0 1

S4 Participated in a community group with shared background characteristics (for example a Veterans organization momrsquos group)

0 1

Well-Being Inventory (05 August 2019) National Center for PTSD Page 20 of 23

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
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      229. Explain living situation
      230. Annual salary
      231. Hourly
      232. estimate
      233. readily available
      234. expenses
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      412. year2
      413. months2
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      480. Children1
      481. Children2
      482. Children3
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      606. Text Field 1
Page 11: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Participant ID

Yes No

G2 Does your household have at least 3 months of your typical income set aside in case of an unexpected fnancial ev ent

Yes No

G3 Does your household have the insurance coverage you andor your family would need if an unexpected financial event were to occur (for example disability insurance property insurance and or life insurance)

Yes No

G4 Has your household begun to set aside money for retirement Yes No

G5 Is your household more than one month behind on your debt payments (for example mortgage or credit card)

No my household is not more than one month behind in debt payments Yes my household is over one month behind in debt payments Not applicable - my household does not have any debt

G6 Are you currently concerned that you will lose your housing and be unable to find stable alternative housing

Yes No

ADMINISTRATOR ASK OF EVERYONE

G7

G8

How many people are supported by your HOUSEHOLD income including yourself your significant other (if you have one) and anyone else partially or fully supported by this income whether or not they live with you

What is your current living situation Rent an apartment house or room Own an apartment or house Live with a friend or relative and not paying rent Live in a dormitory at school Live in a medical or assisted living facility such as a hospital or rehab center Live in transitional housing (for example a halfway house) Live in a car on the street or in a homeless shelter

Well-Being Inventory (05 August 2019) National Center for PTSD Page 9 of 23

Participant ID

Somewhere else (fll-in

ADMINISTRATOR ASK OF THOSE WHO INDICATED THEY WORK FOR PAY IN A1

G9 Please provide your expected annual SALARY before taxes are taken out If you do not know your salary please indicate how much you expect to earn per hour (before taxes) If you do not know the answer please make your best guess

ANNUAL SALARY (before taxes)

-OR-

HOURLY PAY RATE (before taxes)

ADMINISTRATOR ASK OF EVERYONE

G10 Please provide an estimate of your HOUSEHOLDrsquoS yearly income before taxes are taken out Include all sources of income including salary as well as any disability payments real estate income and any other sources of income from all earners in your household If you do not have other sources of income and you are the only earner in your household this may be the same as your salary If you do not know the answer please make your best guess

$

ADMINISTRATOR ASK OF EVERYONE

G11 Approximately how much money does your household have readily available (for example in cash and savings) to cover a financial emergency such as loss of a job If you do not know the answer make your best guess

$

G12 Approximately how much does your HOUSEHOLD pay towards debt and housing expenses PER MONTH (for example mortgagerent bills credit card debt student loans etc)

$

ADMINISTRATOR ASK OF EVERYONE

SECTION 2H

Well-Being Inventory (05 August 2019) National Center for PTSD Page 10 of 22

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most or all of the time

H1 Followed a budget 1 2 3 4 5

H2 Compared prices when purchasing a product or service

1 2 3 4 5

H3 Kept a written or electronic record of your spending

1 2 3 4 5

H4 Been late in paying a bill 1 2 3 4 5

H5 Had credit card debt that you did not pay of each mon th

1 2 3 4 5

H6 Spent more than you could afford on clothing entertainment and other extras

1 2 3 4 5

H7 Contributed part of each paycheck (or other income) to a retirement account such as a 401k or IRA

1 2 3 4 5

H8 Contributed part of each paycheck (or other income) to a personal savings account

1 2 3 4 5

SECTION 2I

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I1 Your ability to pay for necessities 1 2 3 4 5

I2 Your ability to afford extras (for example vacation dinner out)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 11 of 22

Participant ID

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I3 The amount of savings you have 1 2 3 4 5

I4 The amount of debt you have 1 2 3 4 5

SECTION 3 CURRENT HEALTH

In this next section you will be asked about your current physical and emotionalmental health

SECTION 3J

ADMINISTRATOR ASK OF EVERYONE

J1 Do you have an ongoing physical health condition illness or disability (for example high blood pressure pain)

Yes No

J2 Do you have an ongoing mentalemotional health condition illness or disability (for example depression anxiety)

Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE A PHYSICAL HEALTH PROBLEM IN J1 OR A MENTAL HEALTH PROBLEM IN J2

J3 What ongoing physical or mentalemotional health conditions illnesses or disabilities do you have Mark all that apply

High blood pressure or other heart problem High cholesterol Diabetes requiring insulin other medication or special diet Obesity Sleep problem or disorder Chronic pain or pain related disorder (for example knee back migraines)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 12 of 23

Participant ID

Arthritis A hearing condition that is not correctable Alcohol or drug (including prescription drugs) abusedependence Posttraumatic stress disorder Depression Anxiety disorder (for example panic disorder generalized anxiety disorder)Other chronic physical or mental health problem 1 (please specify) Other chronic physical or mental health problem 2 (please specify) Other chronic physical or mental health problem 3 (please specify)

ADMINISTRATOR ASK OF EVERYONE

J4 Do you have healthcare coverage (for example employer-provided health insurance Medicaid) Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATED THAT THEY HAVE HEALTHCARE COVERAGE IN J4

J5 Which of the following best describe your main sources of healthcare coverage Employer-provided health insurance (could be from your current or former employer a family memberrsquos current or former employer or a union) A plan you purchased through a healthcare exchange (for example Healthcaregov State exchange Obamacare etc) TRICARE VA Medicaid Medicare Other government assisted health plan Something else (please specify)

SECTION 3K

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K1 Eaten a generally healthy diet (for example low fat limited sugar adequate servings of fruits and vegetables)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 13 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K2 Gotten at least 2 hours and 30 minutes of moderate physical activity OR 1 hour and 15 minutes of vigorous activity each week

1 2 3 4 5

K3 Done muscle strengthening exercises at least two days per week

1 2 3 4 5

K4 Gotten quality sleep 1 2 3 4 5

K5 Had sexual intercourse without a condom with more than one person or with a person you did not know

1 2 3 4 5

K6 Used tobacco andor nicotine products (for example cigarettes cigars vape)

1 2 3 4 5

K7 Used alcohol in a way that put your health at risk (for example blacking out driving drunk)

1 2 3 4 5

K8 Used drugs (including prescription drugs) in a way that put your health at risk (for example losing memory or consciousness driving under the infuence)

1 2 3 4 5

K9 Completed recommended medical care (for example physical exams)

1 2 3 4 5

K10 Maintained personal cleanliness (for example personal care household chores)

1 2 3 4 5

K11 Spent time doing things that you enjoy

1 2 3 4 5

K12 Spent time doing things that you find personally meaningful

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 14 of 23

Participant ID

SECTION 3L

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

L1 Your physical health 1 2 3 4 5

L2 Your emotionalmental health 1 2 3 4 5

L3 Your health care 1 2 3 4 5

SECTION 4 SOCIAL RELATIONSHIPS

In this next section you will be asked about your romantic relationship involvement

SECTION 4M

ADMINISTRATOR ASK OF EVERYONE

M1 What is your current marital status

Never married Married - first and only marriage Married - second or later marriage Separated Divorced Widowed

ADMINISTRATOR ASK OF THOSE WHO DID NOT INDICATE MARRIED IN M1

M2 Are you currently in a romantic relationship Currently in a relationship and living as a couple Currently in a relationship but not living as a couple Not currently in a relationship

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 15 of 23

Participant ID

M3 How long have you been married or in your current relationship years months

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT MARRIED ON M1 AND NOT IN A RELATIONSHIP ON M2

M4 Which of the following is true with respect to your romantic relationship status I would like to be in a relationship I prefer not to be in a relationship at this time

SECTION 4N

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Over the last 3 months how often have you done the following in your romantic relationship

Never Rarely Sometimes Often Most

or all of the time

N1 Provided your significant other with the emotional support they sought

1 2 3 4 5

N2 Shared your intimate thoughts and feelings

1 2 3 4 5

N3 Done your fair share of day-to-day tasks (for example grocery shopping errands planning activities)

1 2 3 4 5

N4 Initiated leisure time activities that both you and your signifcan t other enjoy

1 2 3 4 5

N5 Made ef ort to work through disagreements respectfully

1 2 3 4 5

N6 Expressed interest andor willingness to engage in regular sexual or physical intimacy

1 2 3 4 5

SECTION 4O

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 16 of 23

Participant ID

Everybody has aspects of their relationship that make them more or less happy Over the last 3 months how satisfied have you been with your significant otherrsquos contribution to the following aspects of your romantic relationship

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

O1Emotional closeness (for example sharing personal thoughts and feelings)

1 2 3 4 5

O2Companionship (for example doing enjoyable activities together)

1 2 3 4 5

O3Sexual and physical intimacy (for example holding hands or having sex)

1 2 3 4 5

O4 Intellectual connection (for example having many things to talk about)

1 2 3 4 5

O5Security (for example being able to trust and depend on partner)

1 2 3 4 5

O6Division of day-to-day tasks (for example your partnerrsquos contribution to chores and planning activities)

1 2 3 4 5

In this next section you will be asked about your parenting experiences

SECTION 4P

P1 Are you a parent or have you served in a parenting role during the past three months Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P2 Do you have children who are age 18 or younger Yes No

Well-Being Inventory (05 August 2019) National Center for PTSD Page 17 of 23

Participant ID

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P3 How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities) Enter a number on each line write 0 if you do not have any children in that age category

Number of Children

Under 5 years old

Age 5 through 12 years old

Age 13 through 18 years old

Age 19 through 26

27 years +

ADMINISTRATOR ASK OF THOSE WHO DO NOT INDICATE HAVING CHILDREN IN P1

P4 Which of the following is true with respect to your parenting status I would like to be a parent now I prefer not to be a parent at this time

SECTION 4Q

ADMINISTRATOR ASK OF ALL THOSE WHO HAVE CHILDREN UNDER 18 IN P2

Please answer the following questions with regard to children 18 or under for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 18 of 23

Participant ID

All parents have strengths and weaknesses Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

Q1Provided a healthy environment for your child(ren) (for example preparing healthy meals caring for their health keeping them safe)

1 2 3 4 5

Q2Been a good example for your child(ren) (for example being respectful during disagreements with others taking good care of your own health)

1 2 3 4 5

Q3Been actively involved in your child(ren)rsquos activities (for example regularly attending sporting and school events giving your full attention during time together)

1 2 3 4 5

Q4Met your child(ren)rsquos needs for physical affection and emotional support (for example giving them hugs being sympathetic to their problems)

1 2 3 4 5

Q5Been able to successfully manage your child(ren)rsquos unique challenges (for example efectively disciplining children)

1 2 3 4 5

SECTION 4R

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

Please answer the following questions with regard to ALL children for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 19 of 23

Participant ID

Parenting can be both rewarding and challenging How satisfed have you been with the following aspects of your parenting experiences over the last 3 months

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

R1 How close you are with your child(ren)

1 2 3 4 5

R2 How much enjoyment you get from parenting

1 2 3 4 5

R3 How your child(ren) are doing in life 1 2 3 4 5

SECTION 4S

ADMINISTRATOR ASK OF EVERYONE

In this next section you will be asked about your experiences in your broader community as well as your relationships with relatives and friends

Over the last 3 months have you regularly done the following

No Yes

S1 Participated in a religious or spiritual community

0 1

S2 Volunteered for a charity political group or other local organization (for example a service organization a political campaign)

0 1

S3 Participated in a community group that shares similar hobbies (for example a sports team a book club)

0 1

S4 Participated in a community group with shared background characteristics (for example a Veterans organization momrsquos group)

0 1

Well-Being Inventory (05 August 2019) National Center for PTSD Page 20 of 23

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
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      606. Text Field 1
Page 12: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Participant ID

Somewhere else (fll-in

ADMINISTRATOR ASK OF THOSE WHO INDICATED THEY WORK FOR PAY IN A1

G9 Please provide your expected annual SALARY before taxes are taken out If you do not know your salary please indicate how much you expect to earn per hour (before taxes) If you do not know the answer please make your best guess

ANNUAL SALARY (before taxes)

-OR-

HOURLY PAY RATE (before taxes)

ADMINISTRATOR ASK OF EVERYONE

G10 Please provide an estimate of your HOUSEHOLDrsquoS yearly income before taxes are taken out Include all sources of income including salary as well as any disability payments real estate income and any other sources of income from all earners in your household If you do not have other sources of income and you are the only earner in your household this may be the same as your salary If you do not know the answer please make your best guess

$

ADMINISTRATOR ASK OF EVERYONE

G11 Approximately how much money does your household have readily available (for example in cash and savings) to cover a financial emergency such as loss of a job If you do not know the answer make your best guess

$

G12 Approximately how much does your HOUSEHOLD pay towards debt and housing expenses PER MONTH (for example mortgagerent bills credit card debt student loans etc)

$

ADMINISTRATOR ASK OF EVERYONE

SECTION 2H

Well-Being Inventory (05 August 2019) National Center for PTSD Page 10 of 22

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most or all of the time

H1 Followed a budget 1 2 3 4 5

H2 Compared prices when purchasing a product or service

1 2 3 4 5

H3 Kept a written or electronic record of your spending

1 2 3 4 5

H4 Been late in paying a bill 1 2 3 4 5

H5 Had credit card debt that you did not pay of each mon th

1 2 3 4 5

H6 Spent more than you could afford on clothing entertainment and other extras

1 2 3 4 5

H7 Contributed part of each paycheck (or other income) to a retirement account such as a 401k or IRA

1 2 3 4 5

H8 Contributed part of each paycheck (or other income) to a personal savings account

1 2 3 4 5

SECTION 2I

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I1 Your ability to pay for necessities 1 2 3 4 5

I2 Your ability to afford extras (for example vacation dinner out)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 11 of 22

Participant ID

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I3 The amount of savings you have 1 2 3 4 5

I4 The amount of debt you have 1 2 3 4 5

SECTION 3 CURRENT HEALTH

In this next section you will be asked about your current physical and emotionalmental health

SECTION 3J

ADMINISTRATOR ASK OF EVERYONE

J1 Do you have an ongoing physical health condition illness or disability (for example high blood pressure pain)

Yes No

J2 Do you have an ongoing mentalemotional health condition illness or disability (for example depression anxiety)

Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE A PHYSICAL HEALTH PROBLEM IN J1 OR A MENTAL HEALTH PROBLEM IN J2

J3 What ongoing physical or mentalemotional health conditions illnesses or disabilities do you have Mark all that apply

High blood pressure or other heart problem High cholesterol Diabetes requiring insulin other medication or special diet Obesity Sleep problem or disorder Chronic pain or pain related disorder (for example knee back migraines)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 12 of 23

Participant ID

Arthritis A hearing condition that is not correctable Alcohol or drug (including prescription drugs) abusedependence Posttraumatic stress disorder Depression Anxiety disorder (for example panic disorder generalized anxiety disorder)Other chronic physical or mental health problem 1 (please specify) Other chronic physical or mental health problem 2 (please specify) Other chronic physical or mental health problem 3 (please specify)

ADMINISTRATOR ASK OF EVERYONE

J4 Do you have healthcare coverage (for example employer-provided health insurance Medicaid) Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATED THAT THEY HAVE HEALTHCARE COVERAGE IN J4

J5 Which of the following best describe your main sources of healthcare coverage Employer-provided health insurance (could be from your current or former employer a family memberrsquos current or former employer or a union) A plan you purchased through a healthcare exchange (for example Healthcaregov State exchange Obamacare etc) TRICARE VA Medicaid Medicare Other government assisted health plan Something else (please specify)

SECTION 3K

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K1 Eaten a generally healthy diet (for example low fat limited sugar adequate servings of fruits and vegetables)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 13 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K2 Gotten at least 2 hours and 30 minutes of moderate physical activity OR 1 hour and 15 minutes of vigorous activity each week

1 2 3 4 5

K3 Done muscle strengthening exercises at least two days per week

1 2 3 4 5

K4 Gotten quality sleep 1 2 3 4 5

K5 Had sexual intercourse without a condom with more than one person or with a person you did not know

1 2 3 4 5

K6 Used tobacco andor nicotine products (for example cigarettes cigars vape)

1 2 3 4 5

K7 Used alcohol in a way that put your health at risk (for example blacking out driving drunk)

1 2 3 4 5

K8 Used drugs (including prescription drugs) in a way that put your health at risk (for example losing memory or consciousness driving under the infuence)

1 2 3 4 5

K9 Completed recommended medical care (for example physical exams)

1 2 3 4 5

K10 Maintained personal cleanliness (for example personal care household chores)

1 2 3 4 5

K11 Spent time doing things that you enjoy

1 2 3 4 5

K12 Spent time doing things that you find personally meaningful

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 14 of 23

Participant ID

SECTION 3L

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

L1 Your physical health 1 2 3 4 5

L2 Your emotionalmental health 1 2 3 4 5

L3 Your health care 1 2 3 4 5

SECTION 4 SOCIAL RELATIONSHIPS

In this next section you will be asked about your romantic relationship involvement

SECTION 4M

ADMINISTRATOR ASK OF EVERYONE

M1 What is your current marital status

Never married Married - first and only marriage Married - second or later marriage Separated Divorced Widowed

ADMINISTRATOR ASK OF THOSE WHO DID NOT INDICATE MARRIED IN M1

M2 Are you currently in a romantic relationship Currently in a relationship and living as a couple Currently in a relationship but not living as a couple Not currently in a relationship

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 15 of 23

Participant ID

M3 How long have you been married or in your current relationship years months

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT MARRIED ON M1 AND NOT IN A RELATIONSHIP ON M2

M4 Which of the following is true with respect to your romantic relationship status I would like to be in a relationship I prefer not to be in a relationship at this time

SECTION 4N

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Over the last 3 months how often have you done the following in your romantic relationship

Never Rarely Sometimes Often Most

or all of the time

N1 Provided your significant other with the emotional support they sought

1 2 3 4 5

N2 Shared your intimate thoughts and feelings

1 2 3 4 5

N3 Done your fair share of day-to-day tasks (for example grocery shopping errands planning activities)

1 2 3 4 5

N4 Initiated leisure time activities that both you and your signifcan t other enjoy

1 2 3 4 5

N5 Made ef ort to work through disagreements respectfully

1 2 3 4 5

N6 Expressed interest andor willingness to engage in regular sexual or physical intimacy

1 2 3 4 5

SECTION 4O

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 16 of 23

Participant ID

Everybody has aspects of their relationship that make them more or less happy Over the last 3 months how satisfied have you been with your significant otherrsquos contribution to the following aspects of your romantic relationship

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

O1Emotional closeness (for example sharing personal thoughts and feelings)

1 2 3 4 5

O2Companionship (for example doing enjoyable activities together)

1 2 3 4 5

O3Sexual and physical intimacy (for example holding hands or having sex)

1 2 3 4 5

O4 Intellectual connection (for example having many things to talk about)

1 2 3 4 5

O5Security (for example being able to trust and depend on partner)

1 2 3 4 5

O6Division of day-to-day tasks (for example your partnerrsquos contribution to chores and planning activities)

1 2 3 4 5

In this next section you will be asked about your parenting experiences

SECTION 4P

P1 Are you a parent or have you served in a parenting role during the past three months Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P2 Do you have children who are age 18 or younger Yes No

Well-Being Inventory (05 August 2019) National Center for PTSD Page 17 of 23

Participant ID

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P3 How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities) Enter a number on each line write 0 if you do not have any children in that age category

Number of Children

Under 5 years old

Age 5 through 12 years old

Age 13 through 18 years old

Age 19 through 26

27 years +

ADMINISTRATOR ASK OF THOSE WHO DO NOT INDICATE HAVING CHILDREN IN P1

P4 Which of the following is true with respect to your parenting status I would like to be a parent now I prefer not to be a parent at this time

SECTION 4Q

ADMINISTRATOR ASK OF ALL THOSE WHO HAVE CHILDREN UNDER 18 IN P2

Please answer the following questions with regard to children 18 or under for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 18 of 23

Participant ID

All parents have strengths and weaknesses Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

Q1Provided a healthy environment for your child(ren) (for example preparing healthy meals caring for their health keeping them safe)

1 2 3 4 5

Q2Been a good example for your child(ren) (for example being respectful during disagreements with others taking good care of your own health)

1 2 3 4 5

Q3Been actively involved in your child(ren)rsquos activities (for example regularly attending sporting and school events giving your full attention during time together)

1 2 3 4 5

Q4Met your child(ren)rsquos needs for physical affection and emotional support (for example giving them hugs being sympathetic to their problems)

1 2 3 4 5

Q5Been able to successfully manage your child(ren)rsquos unique challenges (for example efectively disciplining children)

1 2 3 4 5

SECTION 4R

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

Please answer the following questions with regard to ALL children for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 19 of 23

Participant ID

Parenting can be both rewarding and challenging How satisfed have you been with the following aspects of your parenting experiences over the last 3 months

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

R1 How close you are with your child(ren)

1 2 3 4 5

R2 How much enjoyment you get from parenting

1 2 3 4 5

R3 How your child(ren) are doing in life 1 2 3 4 5

SECTION 4S

ADMINISTRATOR ASK OF EVERYONE

In this next section you will be asked about your experiences in your broader community as well as your relationships with relatives and friends

Over the last 3 months have you regularly done the following

No Yes

S1 Participated in a religious or spiritual community

0 1

S2 Volunteered for a charity political group or other local organization (for example a service organization a political campaign)

0 1

S3 Participated in a community group that shares similar hobbies (for example a sports team a book club)

0 1

S4 Participated in a community group with shared background characteristics (for example a Veterans organization momrsquos group)

0 1

Well-Being Inventory (05 August 2019) National Center for PTSD Page 20 of 23

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
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      230. Annual salary
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      606. Text Field 1
Page 13: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most or all of the time

H1 Followed a budget 1 2 3 4 5

H2 Compared prices when purchasing a product or service

1 2 3 4 5

H3 Kept a written or electronic record of your spending

1 2 3 4 5

H4 Been late in paying a bill 1 2 3 4 5

H5 Had credit card debt that you did not pay of each mon th

1 2 3 4 5

H6 Spent more than you could afford on clothing entertainment and other extras

1 2 3 4 5

H7 Contributed part of each paycheck (or other income) to a retirement account such as a 401k or IRA

1 2 3 4 5

H8 Contributed part of each paycheck (or other income) to a personal savings account

1 2 3 4 5

SECTION 2I

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I1 Your ability to pay for necessities 1 2 3 4 5

I2 Your ability to afford extras (for example vacation dinner out)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 11 of 22

Participant ID

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I3 The amount of savings you have 1 2 3 4 5

I4 The amount of debt you have 1 2 3 4 5

SECTION 3 CURRENT HEALTH

In this next section you will be asked about your current physical and emotionalmental health

SECTION 3J

ADMINISTRATOR ASK OF EVERYONE

J1 Do you have an ongoing physical health condition illness or disability (for example high blood pressure pain)

Yes No

J2 Do you have an ongoing mentalemotional health condition illness or disability (for example depression anxiety)

Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE A PHYSICAL HEALTH PROBLEM IN J1 OR A MENTAL HEALTH PROBLEM IN J2

J3 What ongoing physical or mentalemotional health conditions illnesses or disabilities do you have Mark all that apply

High blood pressure or other heart problem High cholesterol Diabetes requiring insulin other medication or special diet Obesity Sleep problem or disorder Chronic pain or pain related disorder (for example knee back migraines)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 12 of 23

Participant ID

Arthritis A hearing condition that is not correctable Alcohol or drug (including prescription drugs) abusedependence Posttraumatic stress disorder Depression Anxiety disorder (for example panic disorder generalized anxiety disorder)Other chronic physical or mental health problem 1 (please specify) Other chronic physical or mental health problem 2 (please specify) Other chronic physical or mental health problem 3 (please specify)

ADMINISTRATOR ASK OF EVERYONE

J4 Do you have healthcare coverage (for example employer-provided health insurance Medicaid) Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATED THAT THEY HAVE HEALTHCARE COVERAGE IN J4

J5 Which of the following best describe your main sources of healthcare coverage Employer-provided health insurance (could be from your current or former employer a family memberrsquos current or former employer or a union) A plan you purchased through a healthcare exchange (for example Healthcaregov State exchange Obamacare etc) TRICARE VA Medicaid Medicare Other government assisted health plan Something else (please specify)

SECTION 3K

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K1 Eaten a generally healthy diet (for example low fat limited sugar adequate servings of fruits and vegetables)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 13 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K2 Gotten at least 2 hours and 30 minutes of moderate physical activity OR 1 hour and 15 minutes of vigorous activity each week

1 2 3 4 5

K3 Done muscle strengthening exercises at least two days per week

1 2 3 4 5

K4 Gotten quality sleep 1 2 3 4 5

K5 Had sexual intercourse without a condom with more than one person or with a person you did not know

1 2 3 4 5

K6 Used tobacco andor nicotine products (for example cigarettes cigars vape)

1 2 3 4 5

K7 Used alcohol in a way that put your health at risk (for example blacking out driving drunk)

1 2 3 4 5

K8 Used drugs (including prescription drugs) in a way that put your health at risk (for example losing memory or consciousness driving under the infuence)

1 2 3 4 5

K9 Completed recommended medical care (for example physical exams)

1 2 3 4 5

K10 Maintained personal cleanliness (for example personal care household chores)

1 2 3 4 5

K11 Spent time doing things that you enjoy

1 2 3 4 5

K12 Spent time doing things that you find personally meaningful

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 14 of 23

Participant ID

SECTION 3L

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

L1 Your physical health 1 2 3 4 5

L2 Your emotionalmental health 1 2 3 4 5

L3 Your health care 1 2 3 4 5

SECTION 4 SOCIAL RELATIONSHIPS

In this next section you will be asked about your romantic relationship involvement

SECTION 4M

ADMINISTRATOR ASK OF EVERYONE

M1 What is your current marital status

Never married Married - first and only marriage Married - second or later marriage Separated Divorced Widowed

ADMINISTRATOR ASK OF THOSE WHO DID NOT INDICATE MARRIED IN M1

M2 Are you currently in a romantic relationship Currently in a relationship and living as a couple Currently in a relationship but not living as a couple Not currently in a relationship

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 15 of 23

Participant ID

M3 How long have you been married or in your current relationship years months

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT MARRIED ON M1 AND NOT IN A RELATIONSHIP ON M2

M4 Which of the following is true with respect to your romantic relationship status I would like to be in a relationship I prefer not to be in a relationship at this time

SECTION 4N

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Over the last 3 months how often have you done the following in your romantic relationship

Never Rarely Sometimes Often Most

or all of the time

N1 Provided your significant other with the emotional support they sought

1 2 3 4 5

N2 Shared your intimate thoughts and feelings

1 2 3 4 5

N3 Done your fair share of day-to-day tasks (for example grocery shopping errands planning activities)

1 2 3 4 5

N4 Initiated leisure time activities that both you and your signifcan t other enjoy

1 2 3 4 5

N5 Made ef ort to work through disagreements respectfully

1 2 3 4 5

N6 Expressed interest andor willingness to engage in regular sexual or physical intimacy

1 2 3 4 5

SECTION 4O

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 16 of 23

Participant ID

Everybody has aspects of their relationship that make them more or less happy Over the last 3 months how satisfied have you been with your significant otherrsquos contribution to the following aspects of your romantic relationship

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

O1Emotional closeness (for example sharing personal thoughts and feelings)

1 2 3 4 5

O2Companionship (for example doing enjoyable activities together)

1 2 3 4 5

O3Sexual and physical intimacy (for example holding hands or having sex)

1 2 3 4 5

O4 Intellectual connection (for example having many things to talk about)

1 2 3 4 5

O5Security (for example being able to trust and depend on partner)

1 2 3 4 5

O6Division of day-to-day tasks (for example your partnerrsquos contribution to chores and planning activities)

1 2 3 4 5

In this next section you will be asked about your parenting experiences

SECTION 4P

P1 Are you a parent or have you served in a parenting role during the past three months Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P2 Do you have children who are age 18 or younger Yes No

Well-Being Inventory (05 August 2019) National Center for PTSD Page 17 of 23

Participant ID

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P3 How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities) Enter a number on each line write 0 if you do not have any children in that age category

Number of Children

Under 5 years old

Age 5 through 12 years old

Age 13 through 18 years old

Age 19 through 26

27 years +

ADMINISTRATOR ASK OF THOSE WHO DO NOT INDICATE HAVING CHILDREN IN P1

P4 Which of the following is true with respect to your parenting status I would like to be a parent now I prefer not to be a parent at this time

SECTION 4Q

ADMINISTRATOR ASK OF ALL THOSE WHO HAVE CHILDREN UNDER 18 IN P2

Please answer the following questions with regard to children 18 or under for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 18 of 23

Participant ID

All parents have strengths and weaknesses Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

Q1Provided a healthy environment for your child(ren) (for example preparing healthy meals caring for their health keeping them safe)

1 2 3 4 5

Q2Been a good example for your child(ren) (for example being respectful during disagreements with others taking good care of your own health)

1 2 3 4 5

Q3Been actively involved in your child(ren)rsquos activities (for example regularly attending sporting and school events giving your full attention during time together)

1 2 3 4 5

Q4Met your child(ren)rsquos needs for physical affection and emotional support (for example giving them hugs being sympathetic to their problems)

1 2 3 4 5

Q5Been able to successfully manage your child(ren)rsquos unique challenges (for example efectively disciplining children)

1 2 3 4 5

SECTION 4R

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

Please answer the following questions with regard to ALL children for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 19 of 23

Participant ID

Parenting can be both rewarding and challenging How satisfed have you been with the following aspects of your parenting experiences over the last 3 months

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

R1 How close you are with your child(ren)

1 2 3 4 5

R2 How much enjoyment you get from parenting

1 2 3 4 5

R3 How your child(ren) are doing in life 1 2 3 4 5

SECTION 4S

ADMINISTRATOR ASK OF EVERYONE

In this next section you will be asked about your experiences in your broader community as well as your relationships with relatives and friends

Over the last 3 months have you regularly done the following

No Yes

S1 Participated in a religious or spiritual community

0 1

S2 Volunteered for a charity political group or other local organization (for example a service organization a political campaign)

0 1

S3 Participated in a community group that shares similar hobbies (for example a sports team a book club)

0 1

S4 Participated in a community group with shared background characteristics (for example a Veterans organization momrsquos group)

0 1

Well-Being Inventory (05 August 2019) National Center for PTSD Page 20 of 23

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
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      606. Text Field 1
Page 14: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Participant ID

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

I3 The amount of savings you have 1 2 3 4 5

I4 The amount of debt you have 1 2 3 4 5

SECTION 3 CURRENT HEALTH

In this next section you will be asked about your current physical and emotionalmental health

SECTION 3J

ADMINISTRATOR ASK OF EVERYONE

J1 Do you have an ongoing physical health condition illness or disability (for example high blood pressure pain)

Yes No

J2 Do you have an ongoing mentalemotional health condition illness or disability (for example depression anxiety)

Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE A PHYSICAL HEALTH PROBLEM IN J1 OR A MENTAL HEALTH PROBLEM IN J2

J3 What ongoing physical or mentalemotional health conditions illnesses or disabilities do you have Mark all that apply

High blood pressure or other heart problem High cholesterol Diabetes requiring insulin other medication or special diet Obesity Sleep problem or disorder Chronic pain or pain related disorder (for example knee back migraines)

Well-Being Inventory (05 August 2019) National Center for PTSD Page 12 of 23

Participant ID

Arthritis A hearing condition that is not correctable Alcohol or drug (including prescription drugs) abusedependence Posttraumatic stress disorder Depression Anxiety disorder (for example panic disorder generalized anxiety disorder)Other chronic physical or mental health problem 1 (please specify) Other chronic physical or mental health problem 2 (please specify) Other chronic physical or mental health problem 3 (please specify)

ADMINISTRATOR ASK OF EVERYONE

J4 Do you have healthcare coverage (for example employer-provided health insurance Medicaid) Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATED THAT THEY HAVE HEALTHCARE COVERAGE IN J4

J5 Which of the following best describe your main sources of healthcare coverage Employer-provided health insurance (could be from your current or former employer a family memberrsquos current or former employer or a union) A plan you purchased through a healthcare exchange (for example Healthcaregov State exchange Obamacare etc) TRICARE VA Medicaid Medicare Other government assisted health plan Something else (please specify)

SECTION 3K

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K1 Eaten a generally healthy diet (for example low fat limited sugar adequate servings of fruits and vegetables)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 13 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K2 Gotten at least 2 hours and 30 minutes of moderate physical activity OR 1 hour and 15 minutes of vigorous activity each week

1 2 3 4 5

K3 Done muscle strengthening exercises at least two days per week

1 2 3 4 5

K4 Gotten quality sleep 1 2 3 4 5

K5 Had sexual intercourse without a condom with more than one person or with a person you did not know

1 2 3 4 5

K6 Used tobacco andor nicotine products (for example cigarettes cigars vape)

1 2 3 4 5

K7 Used alcohol in a way that put your health at risk (for example blacking out driving drunk)

1 2 3 4 5

K8 Used drugs (including prescription drugs) in a way that put your health at risk (for example losing memory or consciousness driving under the infuence)

1 2 3 4 5

K9 Completed recommended medical care (for example physical exams)

1 2 3 4 5

K10 Maintained personal cleanliness (for example personal care household chores)

1 2 3 4 5

K11 Spent time doing things that you enjoy

1 2 3 4 5

K12 Spent time doing things that you find personally meaningful

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 14 of 23

Participant ID

SECTION 3L

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

L1 Your physical health 1 2 3 4 5

L2 Your emotionalmental health 1 2 3 4 5

L3 Your health care 1 2 3 4 5

SECTION 4 SOCIAL RELATIONSHIPS

In this next section you will be asked about your romantic relationship involvement

SECTION 4M

ADMINISTRATOR ASK OF EVERYONE

M1 What is your current marital status

Never married Married - first and only marriage Married - second or later marriage Separated Divorced Widowed

ADMINISTRATOR ASK OF THOSE WHO DID NOT INDICATE MARRIED IN M1

M2 Are you currently in a romantic relationship Currently in a relationship and living as a couple Currently in a relationship but not living as a couple Not currently in a relationship

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 15 of 23

Participant ID

M3 How long have you been married or in your current relationship years months

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT MARRIED ON M1 AND NOT IN A RELATIONSHIP ON M2

M4 Which of the following is true with respect to your romantic relationship status I would like to be in a relationship I prefer not to be in a relationship at this time

SECTION 4N

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Over the last 3 months how often have you done the following in your romantic relationship

Never Rarely Sometimes Often Most

or all of the time

N1 Provided your significant other with the emotional support they sought

1 2 3 4 5

N2 Shared your intimate thoughts and feelings

1 2 3 4 5

N3 Done your fair share of day-to-day tasks (for example grocery shopping errands planning activities)

1 2 3 4 5

N4 Initiated leisure time activities that both you and your signifcan t other enjoy

1 2 3 4 5

N5 Made ef ort to work through disagreements respectfully

1 2 3 4 5

N6 Expressed interest andor willingness to engage in regular sexual or physical intimacy

1 2 3 4 5

SECTION 4O

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 16 of 23

Participant ID

Everybody has aspects of their relationship that make them more or less happy Over the last 3 months how satisfied have you been with your significant otherrsquos contribution to the following aspects of your romantic relationship

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

O1Emotional closeness (for example sharing personal thoughts and feelings)

1 2 3 4 5

O2Companionship (for example doing enjoyable activities together)

1 2 3 4 5

O3Sexual and physical intimacy (for example holding hands or having sex)

1 2 3 4 5

O4 Intellectual connection (for example having many things to talk about)

1 2 3 4 5

O5Security (for example being able to trust and depend on partner)

1 2 3 4 5

O6Division of day-to-day tasks (for example your partnerrsquos contribution to chores and planning activities)

1 2 3 4 5

In this next section you will be asked about your parenting experiences

SECTION 4P

P1 Are you a parent or have you served in a parenting role during the past three months Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P2 Do you have children who are age 18 or younger Yes No

Well-Being Inventory (05 August 2019) National Center for PTSD Page 17 of 23

Participant ID

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P3 How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities) Enter a number on each line write 0 if you do not have any children in that age category

Number of Children

Under 5 years old

Age 5 through 12 years old

Age 13 through 18 years old

Age 19 through 26

27 years +

ADMINISTRATOR ASK OF THOSE WHO DO NOT INDICATE HAVING CHILDREN IN P1

P4 Which of the following is true with respect to your parenting status I would like to be a parent now I prefer not to be a parent at this time

SECTION 4Q

ADMINISTRATOR ASK OF ALL THOSE WHO HAVE CHILDREN UNDER 18 IN P2

Please answer the following questions with regard to children 18 or under for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 18 of 23

Participant ID

All parents have strengths and weaknesses Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

Q1Provided a healthy environment for your child(ren) (for example preparing healthy meals caring for their health keeping them safe)

1 2 3 4 5

Q2Been a good example for your child(ren) (for example being respectful during disagreements with others taking good care of your own health)

1 2 3 4 5

Q3Been actively involved in your child(ren)rsquos activities (for example regularly attending sporting and school events giving your full attention during time together)

1 2 3 4 5

Q4Met your child(ren)rsquos needs for physical affection and emotional support (for example giving them hugs being sympathetic to their problems)

1 2 3 4 5

Q5Been able to successfully manage your child(ren)rsquos unique challenges (for example efectively disciplining children)

1 2 3 4 5

SECTION 4R

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

Please answer the following questions with regard to ALL children for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 19 of 23

Participant ID

Parenting can be both rewarding and challenging How satisfed have you been with the following aspects of your parenting experiences over the last 3 months

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

R1 How close you are with your child(ren)

1 2 3 4 5

R2 How much enjoyment you get from parenting

1 2 3 4 5

R3 How your child(ren) are doing in life 1 2 3 4 5

SECTION 4S

ADMINISTRATOR ASK OF EVERYONE

In this next section you will be asked about your experiences in your broader community as well as your relationships with relatives and friends

Over the last 3 months have you regularly done the following

No Yes

S1 Participated in a religious or spiritual community

0 1

S2 Volunteered for a charity political group or other local organization (for example a service organization a political campaign)

0 1

S3 Participated in a community group that shares similar hobbies (for example a sports team a book club)

0 1

S4 Participated in a community group with shared background characteristics (for example a Veterans organization momrsquos group)

0 1

Well-Being Inventory (05 August 2019) National Center for PTSD Page 20 of 23

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
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      228. Somewhere Off
      229. Explain living situation
      230. Annual salary
      231. Hourly
      232. estimate
      233. readily available
      234. expenses
      235. H1-1 Off
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      312. Specify other problem1
      313. Specify other problem2
      314. Specify other problem3
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      412. year2
      413. months2
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      606. Text Field 1
Page 15: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Participant ID

Arthritis A hearing condition that is not correctable Alcohol or drug (including prescription drugs) abusedependence Posttraumatic stress disorder Depression Anxiety disorder (for example panic disorder generalized anxiety disorder)Other chronic physical or mental health problem 1 (please specify) Other chronic physical or mental health problem 2 (please specify) Other chronic physical or mental health problem 3 (please specify)

ADMINISTRATOR ASK OF EVERYONE

J4 Do you have healthcare coverage (for example employer-provided health insurance Medicaid) Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATED THAT THEY HAVE HEALTHCARE COVERAGE IN J4

J5 Which of the following best describe your main sources of healthcare coverage Employer-provided health insurance (could be from your current or former employer a family memberrsquos current or former employer or a union) A plan you purchased through a healthcare exchange (for example Healthcaregov State exchange Obamacare etc) TRICARE VA Medicaid Medicare Other government assisted health plan Something else (please specify)

SECTION 3K

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K1 Eaten a generally healthy diet (for example low fat limited sugar adequate servings of fruits and vegetables)

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 13 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K2 Gotten at least 2 hours and 30 minutes of moderate physical activity OR 1 hour and 15 minutes of vigorous activity each week

1 2 3 4 5

K3 Done muscle strengthening exercises at least two days per week

1 2 3 4 5

K4 Gotten quality sleep 1 2 3 4 5

K5 Had sexual intercourse without a condom with more than one person or with a person you did not know

1 2 3 4 5

K6 Used tobacco andor nicotine products (for example cigarettes cigars vape)

1 2 3 4 5

K7 Used alcohol in a way that put your health at risk (for example blacking out driving drunk)

1 2 3 4 5

K8 Used drugs (including prescription drugs) in a way that put your health at risk (for example losing memory or consciousness driving under the infuence)

1 2 3 4 5

K9 Completed recommended medical care (for example physical exams)

1 2 3 4 5

K10 Maintained personal cleanliness (for example personal care household chores)

1 2 3 4 5

K11 Spent time doing things that you enjoy

1 2 3 4 5

K12 Spent time doing things that you find personally meaningful

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 14 of 23

Participant ID

SECTION 3L

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

L1 Your physical health 1 2 3 4 5

L2 Your emotionalmental health 1 2 3 4 5

L3 Your health care 1 2 3 4 5

SECTION 4 SOCIAL RELATIONSHIPS

In this next section you will be asked about your romantic relationship involvement

SECTION 4M

ADMINISTRATOR ASK OF EVERYONE

M1 What is your current marital status

Never married Married - first and only marriage Married - second or later marriage Separated Divorced Widowed

ADMINISTRATOR ASK OF THOSE WHO DID NOT INDICATE MARRIED IN M1

M2 Are you currently in a romantic relationship Currently in a relationship and living as a couple Currently in a relationship but not living as a couple Not currently in a relationship

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 15 of 23

Participant ID

M3 How long have you been married or in your current relationship years months

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT MARRIED ON M1 AND NOT IN A RELATIONSHIP ON M2

M4 Which of the following is true with respect to your romantic relationship status I would like to be in a relationship I prefer not to be in a relationship at this time

SECTION 4N

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Over the last 3 months how often have you done the following in your romantic relationship

Never Rarely Sometimes Often Most

or all of the time

N1 Provided your significant other with the emotional support they sought

1 2 3 4 5

N2 Shared your intimate thoughts and feelings

1 2 3 4 5

N3 Done your fair share of day-to-day tasks (for example grocery shopping errands planning activities)

1 2 3 4 5

N4 Initiated leisure time activities that both you and your signifcan t other enjoy

1 2 3 4 5

N5 Made ef ort to work through disagreements respectfully

1 2 3 4 5

N6 Expressed interest andor willingness to engage in regular sexual or physical intimacy

1 2 3 4 5

SECTION 4O

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 16 of 23

Participant ID

Everybody has aspects of their relationship that make them more or less happy Over the last 3 months how satisfied have you been with your significant otherrsquos contribution to the following aspects of your romantic relationship

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

O1Emotional closeness (for example sharing personal thoughts and feelings)

1 2 3 4 5

O2Companionship (for example doing enjoyable activities together)

1 2 3 4 5

O3Sexual and physical intimacy (for example holding hands or having sex)

1 2 3 4 5

O4 Intellectual connection (for example having many things to talk about)

1 2 3 4 5

O5Security (for example being able to trust and depend on partner)

1 2 3 4 5

O6Division of day-to-day tasks (for example your partnerrsquos contribution to chores and planning activities)

1 2 3 4 5

In this next section you will be asked about your parenting experiences

SECTION 4P

P1 Are you a parent or have you served in a parenting role during the past three months Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P2 Do you have children who are age 18 or younger Yes No

Well-Being Inventory (05 August 2019) National Center for PTSD Page 17 of 23

Participant ID

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P3 How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities) Enter a number on each line write 0 if you do not have any children in that age category

Number of Children

Under 5 years old

Age 5 through 12 years old

Age 13 through 18 years old

Age 19 through 26

27 years +

ADMINISTRATOR ASK OF THOSE WHO DO NOT INDICATE HAVING CHILDREN IN P1

P4 Which of the following is true with respect to your parenting status I would like to be a parent now I prefer not to be a parent at this time

SECTION 4Q

ADMINISTRATOR ASK OF ALL THOSE WHO HAVE CHILDREN UNDER 18 IN P2

Please answer the following questions with regard to children 18 or under for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 18 of 23

Participant ID

All parents have strengths and weaknesses Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

Q1Provided a healthy environment for your child(ren) (for example preparing healthy meals caring for their health keeping them safe)

1 2 3 4 5

Q2Been a good example for your child(ren) (for example being respectful during disagreements with others taking good care of your own health)

1 2 3 4 5

Q3Been actively involved in your child(ren)rsquos activities (for example regularly attending sporting and school events giving your full attention during time together)

1 2 3 4 5

Q4Met your child(ren)rsquos needs for physical affection and emotional support (for example giving them hugs being sympathetic to their problems)

1 2 3 4 5

Q5Been able to successfully manage your child(ren)rsquos unique challenges (for example efectively disciplining children)

1 2 3 4 5

SECTION 4R

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

Please answer the following questions with regard to ALL children for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 19 of 23

Participant ID

Parenting can be both rewarding and challenging How satisfed have you been with the following aspects of your parenting experiences over the last 3 months

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

R1 How close you are with your child(ren)

1 2 3 4 5

R2 How much enjoyment you get from parenting

1 2 3 4 5

R3 How your child(ren) are doing in life 1 2 3 4 5

SECTION 4S

ADMINISTRATOR ASK OF EVERYONE

In this next section you will be asked about your experiences in your broader community as well as your relationships with relatives and friends

Over the last 3 months have you regularly done the following

No Yes

S1 Participated in a religious or spiritual community

0 1

S2 Volunteered for a charity political group or other local organization (for example a service organization a political campaign)

0 1

S3 Participated in a community group that shares similar hobbies (for example a sports team a book club)

0 1

S4 Participated in a community group with shared background characteristics (for example a Veterans organization momrsquos group)

0 1

Well-Being Inventory (05 August 2019) National Center for PTSD Page 20 of 23

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
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      606. Text Field 1
Page 16: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

K2 Gotten at least 2 hours and 30 minutes of moderate physical activity OR 1 hour and 15 minutes of vigorous activity each week

1 2 3 4 5

K3 Done muscle strengthening exercises at least two days per week

1 2 3 4 5

K4 Gotten quality sleep 1 2 3 4 5

K5 Had sexual intercourse without a condom with more than one person or with a person you did not know

1 2 3 4 5

K6 Used tobacco andor nicotine products (for example cigarettes cigars vape)

1 2 3 4 5

K7 Used alcohol in a way that put your health at risk (for example blacking out driving drunk)

1 2 3 4 5

K8 Used drugs (including prescription drugs) in a way that put your health at risk (for example losing memory or consciousness driving under the infuence)

1 2 3 4 5

K9 Completed recommended medical care (for example physical exams)

1 2 3 4 5

K10 Maintained personal cleanliness (for example personal care household chores)

1 2 3 4 5

K11 Spent time doing things that you enjoy

1 2 3 4 5

K12 Spent time doing things that you find personally meaningful

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 14 of 23

Participant ID

SECTION 3L

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

L1 Your physical health 1 2 3 4 5

L2 Your emotionalmental health 1 2 3 4 5

L3 Your health care 1 2 3 4 5

SECTION 4 SOCIAL RELATIONSHIPS

In this next section you will be asked about your romantic relationship involvement

SECTION 4M

ADMINISTRATOR ASK OF EVERYONE

M1 What is your current marital status

Never married Married - first and only marriage Married - second or later marriage Separated Divorced Widowed

ADMINISTRATOR ASK OF THOSE WHO DID NOT INDICATE MARRIED IN M1

M2 Are you currently in a romantic relationship Currently in a relationship and living as a couple Currently in a relationship but not living as a couple Not currently in a relationship

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 15 of 23

Participant ID

M3 How long have you been married or in your current relationship years months

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT MARRIED ON M1 AND NOT IN A RELATIONSHIP ON M2

M4 Which of the following is true with respect to your romantic relationship status I would like to be in a relationship I prefer not to be in a relationship at this time

SECTION 4N

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Over the last 3 months how often have you done the following in your romantic relationship

Never Rarely Sometimes Often Most

or all of the time

N1 Provided your significant other with the emotional support they sought

1 2 3 4 5

N2 Shared your intimate thoughts and feelings

1 2 3 4 5

N3 Done your fair share of day-to-day tasks (for example grocery shopping errands planning activities)

1 2 3 4 5

N4 Initiated leisure time activities that both you and your signifcan t other enjoy

1 2 3 4 5

N5 Made ef ort to work through disagreements respectfully

1 2 3 4 5

N6 Expressed interest andor willingness to engage in regular sexual or physical intimacy

1 2 3 4 5

SECTION 4O

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 16 of 23

Participant ID

Everybody has aspects of their relationship that make them more or less happy Over the last 3 months how satisfied have you been with your significant otherrsquos contribution to the following aspects of your romantic relationship

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

O1Emotional closeness (for example sharing personal thoughts and feelings)

1 2 3 4 5

O2Companionship (for example doing enjoyable activities together)

1 2 3 4 5

O3Sexual and physical intimacy (for example holding hands or having sex)

1 2 3 4 5

O4 Intellectual connection (for example having many things to talk about)

1 2 3 4 5

O5Security (for example being able to trust and depend on partner)

1 2 3 4 5

O6Division of day-to-day tasks (for example your partnerrsquos contribution to chores and planning activities)

1 2 3 4 5

In this next section you will be asked about your parenting experiences

SECTION 4P

P1 Are you a parent or have you served in a parenting role during the past three months Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P2 Do you have children who are age 18 or younger Yes No

Well-Being Inventory (05 August 2019) National Center for PTSD Page 17 of 23

Participant ID

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P3 How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities) Enter a number on each line write 0 if you do not have any children in that age category

Number of Children

Under 5 years old

Age 5 through 12 years old

Age 13 through 18 years old

Age 19 through 26

27 years +

ADMINISTRATOR ASK OF THOSE WHO DO NOT INDICATE HAVING CHILDREN IN P1

P4 Which of the following is true with respect to your parenting status I would like to be a parent now I prefer not to be a parent at this time

SECTION 4Q

ADMINISTRATOR ASK OF ALL THOSE WHO HAVE CHILDREN UNDER 18 IN P2

Please answer the following questions with regard to children 18 or under for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 18 of 23

Participant ID

All parents have strengths and weaknesses Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

Q1Provided a healthy environment for your child(ren) (for example preparing healthy meals caring for their health keeping them safe)

1 2 3 4 5

Q2Been a good example for your child(ren) (for example being respectful during disagreements with others taking good care of your own health)

1 2 3 4 5

Q3Been actively involved in your child(ren)rsquos activities (for example regularly attending sporting and school events giving your full attention during time together)

1 2 3 4 5

Q4Met your child(ren)rsquos needs for physical affection and emotional support (for example giving them hugs being sympathetic to their problems)

1 2 3 4 5

Q5Been able to successfully manage your child(ren)rsquos unique challenges (for example efectively disciplining children)

1 2 3 4 5

SECTION 4R

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

Please answer the following questions with regard to ALL children for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 19 of 23

Participant ID

Parenting can be both rewarding and challenging How satisfed have you been with the following aspects of your parenting experiences over the last 3 months

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

R1 How close you are with your child(ren)

1 2 3 4 5

R2 How much enjoyment you get from parenting

1 2 3 4 5

R3 How your child(ren) are doing in life 1 2 3 4 5

SECTION 4S

ADMINISTRATOR ASK OF EVERYONE

In this next section you will be asked about your experiences in your broader community as well as your relationships with relatives and friends

Over the last 3 months have you regularly done the following

No Yes

S1 Participated in a religious or spiritual community

0 1

S2 Volunteered for a charity political group or other local organization (for example a service organization a political campaign)

0 1

S3 Participated in a community group that shares similar hobbies (for example a sports team a book club)

0 1

S4 Participated in a community group with shared background characteristics (for example a Veterans organization momrsquos group)

0 1

Well-Being Inventory (05 August 2019) National Center for PTSD Page 20 of 23

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
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      606. Text Field 1
Page 17: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Participant ID

SECTION 3L

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfied have you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

L1 Your physical health 1 2 3 4 5

L2 Your emotionalmental health 1 2 3 4 5

L3 Your health care 1 2 3 4 5

SECTION 4 SOCIAL RELATIONSHIPS

In this next section you will be asked about your romantic relationship involvement

SECTION 4M

ADMINISTRATOR ASK OF EVERYONE

M1 What is your current marital status

Never married Married - first and only marriage Married - second or later marriage Separated Divorced Widowed

ADMINISTRATOR ASK OF THOSE WHO DID NOT INDICATE MARRIED IN M1

M2 Are you currently in a romantic relationship Currently in a relationship and living as a couple Currently in a relationship but not living as a couple Not currently in a relationship

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 15 of 23

Participant ID

M3 How long have you been married or in your current relationship years months

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT MARRIED ON M1 AND NOT IN A RELATIONSHIP ON M2

M4 Which of the following is true with respect to your romantic relationship status I would like to be in a relationship I prefer not to be in a relationship at this time

SECTION 4N

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Over the last 3 months how often have you done the following in your romantic relationship

Never Rarely Sometimes Often Most

or all of the time

N1 Provided your significant other with the emotional support they sought

1 2 3 4 5

N2 Shared your intimate thoughts and feelings

1 2 3 4 5

N3 Done your fair share of day-to-day tasks (for example grocery shopping errands planning activities)

1 2 3 4 5

N4 Initiated leisure time activities that both you and your signifcan t other enjoy

1 2 3 4 5

N5 Made ef ort to work through disagreements respectfully

1 2 3 4 5

N6 Expressed interest andor willingness to engage in regular sexual or physical intimacy

1 2 3 4 5

SECTION 4O

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 16 of 23

Participant ID

Everybody has aspects of their relationship that make them more or less happy Over the last 3 months how satisfied have you been with your significant otherrsquos contribution to the following aspects of your romantic relationship

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

O1Emotional closeness (for example sharing personal thoughts and feelings)

1 2 3 4 5

O2Companionship (for example doing enjoyable activities together)

1 2 3 4 5

O3Sexual and physical intimacy (for example holding hands or having sex)

1 2 3 4 5

O4 Intellectual connection (for example having many things to talk about)

1 2 3 4 5

O5Security (for example being able to trust and depend on partner)

1 2 3 4 5

O6Division of day-to-day tasks (for example your partnerrsquos contribution to chores and planning activities)

1 2 3 4 5

In this next section you will be asked about your parenting experiences

SECTION 4P

P1 Are you a parent or have you served in a parenting role during the past three months Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P2 Do you have children who are age 18 or younger Yes No

Well-Being Inventory (05 August 2019) National Center for PTSD Page 17 of 23

Participant ID

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P3 How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities) Enter a number on each line write 0 if you do not have any children in that age category

Number of Children

Under 5 years old

Age 5 through 12 years old

Age 13 through 18 years old

Age 19 through 26

27 years +

ADMINISTRATOR ASK OF THOSE WHO DO NOT INDICATE HAVING CHILDREN IN P1

P4 Which of the following is true with respect to your parenting status I would like to be a parent now I prefer not to be a parent at this time

SECTION 4Q

ADMINISTRATOR ASK OF ALL THOSE WHO HAVE CHILDREN UNDER 18 IN P2

Please answer the following questions with regard to children 18 or under for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 18 of 23

Participant ID

All parents have strengths and weaknesses Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

Q1Provided a healthy environment for your child(ren) (for example preparing healthy meals caring for their health keeping them safe)

1 2 3 4 5

Q2Been a good example for your child(ren) (for example being respectful during disagreements with others taking good care of your own health)

1 2 3 4 5

Q3Been actively involved in your child(ren)rsquos activities (for example regularly attending sporting and school events giving your full attention during time together)

1 2 3 4 5

Q4Met your child(ren)rsquos needs for physical affection and emotional support (for example giving them hugs being sympathetic to their problems)

1 2 3 4 5

Q5Been able to successfully manage your child(ren)rsquos unique challenges (for example efectively disciplining children)

1 2 3 4 5

SECTION 4R

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

Please answer the following questions with regard to ALL children for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 19 of 23

Participant ID

Parenting can be both rewarding and challenging How satisfed have you been with the following aspects of your parenting experiences over the last 3 months

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

R1 How close you are with your child(ren)

1 2 3 4 5

R2 How much enjoyment you get from parenting

1 2 3 4 5

R3 How your child(ren) are doing in life 1 2 3 4 5

SECTION 4S

ADMINISTRATOR ASK OF EVERYONE

In this next section you will be asked about your experiences in your broader community as well as your relationships with relatives and friends

Over the last 3 months have you regularly done the following

No Yes

S1 Participated in a religious or spiritual community

0 1

S2 Volunteered for a charity political group or other local organization (for example a service organization a political campaign)

0 1

S3 Participated in a community group that shares similar hobbies (for example a sports team a book club)

0 1

S4 Participated in a community group with shared background characteristics (for example a Veterans organization momrsquos group)

0 1

Well-Being Inventory (05 August 2019) National Center for PTSD Page 20 of 23

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
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      606. Text Field 1
Page 18: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Participant ID

M3 How long have you been married or in your current relationship years months

ADMINISTRATOR ASK OF THOSE WHO INDICATE NOT MARRIED ON M1 AND NOT IN A RELATIONSHIP ON M2

M4 Which of the following is true with respect to your romantic relationship status I would like to be in a relationship I prefer not to be in a relationship at this time

SECTION 4N

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Over the last 3 months how often have you done the following in your romantic relationship

Never Rarely Sometimes Often Most

or all of the time

N1 Provided your significant other with the emotional support they sought

1 2 3 4 5

N2 Shared your intimate thoughts and feelings

1 2 3 4 5

N3 Done your fair share of day-to-day tasks (for example grocery shopping errands planning activities)

1 2 3 4 5

N4 Initiated leisure time activities that both you and your signifcan t other enjoy

1 2 3 4 5

N5 Made ef ort to work through disagreements respectfully

1 2 3 4 5

N6 Expressed interest andor willingness to engage in regular sexual or physical intimacy

1 2 3 4 5

SECTION 4O

ADMINISTRATOR ASK OF THOSE WHO INDICATE MARRIED ON M1 OR IN A RELATIONSHIP ON M2

Well-Being Inventory (05 August 2019) National Center for PTSD Page 16 of 23

Participant ID

Everybody has aspects of their relationship that make them more or less happy Over the last 3 months how satisfied have you been with your significant otherrsquos contribution to the following aspects of your romantic relationship

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

O1Emotional closeness (for example sharing personal thoughts and feelings)

1 2 3 4 5

O2Companionship (for example doing enjoyable activities together)

1 2 3 4 5

O3Sexual and physical intimacy (for example holding hands or having sex)

1 2 3 4 5

O4 Intellectual connection (for example having many things to talk about)

1 2 3 4 5

O5Security (for example being able to trust and depend on partner)

1 2 3 4 5

O6Division of day-to-day tasks (for example your partnerrsquos contribution to chores and planning activities)

1 2 3 4 5

In this next section you will be asked about your parenting experiences

SECTION 4P

P1 Are you a parent or have you served in a parenting role during the past three months Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P2 Do you have children who are age 18 or younger Yes No

Well-Being Inventory (05 August 2019) National Center for PTSD Page 17 of 23

Participant ID

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P3 How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities) Enter a number on each line write 0 if you do not have any children in that age category

Number of Children

Under 5 years old

Age 5 through 12 years old

Age 13 through 18 years old

Age 19 through 26

27 years +

ADMINISTRATOR ASK OF THOSE WHO DO NOT INDICATE HAVING CHILDREN IN P1

P4 Which of the following is true with respect to your parenting status I would like to be a parent now I prefer not to be a parent at this time

SECTION 4Q

ADMINISTRATOR ASK OF ALL THOSE WHO HAVE CHILDREN UNDER 18 IN P2

Please answer the following questions with regard to children 18 or under for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 18 of 23

Participant ID

All parents have strengths and weaknesses Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

Q1Provided a healthy environment for your child(ren) (for example preparing healthy meals caring for their health keeping them safe)

1 2 3 4 5

Q2Been a good example for your child(ren) (for example being respectful during disagreements with others taking good care of your own health)

1 2 3 4 5

Q3Been actively involved in your child(ren)rsquos activities (for example regularly attending sporting and school events giving your full attention during time together)

1 2 3 4 5

Q4Met your child(ren)rsquos needs for physical affection and emotional support (for example giving them hugs being sympathetic to their problems)

1 2 3 4 5

Q5Been able to successfully manage your child(ren)rsquos unique challenges (for example efectively disciplining children)

1 2 3 4 5

SECTION 4R

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

Please answer the following questions with regard to ALL children for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 19 of 23

Participant ID

Parenting can be both rewarding and challenging How satisfed have you been with the following aspects of your parenting experiences over the last 3 months

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

R1 How close you are with your child(ren)

1 2 3 4 5

R2 How much enjoyment you get from parenting

1 2 3 4 5

R3 How your child(ren) are doing in life 1 2 3 4 5

SECTION 4S

ADMINISTRATOR ASK OF EVERYONE

In this next section you will be asked about your experiences in your broader community as well as your relationships with relatives and friends

Over the last 3 months have you regularly done the following

No Yes

S1 Participated in a religious or spiritual community

0 1

S2 Volunteered for a charity political group or other local organization (for example a service organization a political campaign)

0 1

S3 Participated in a community group that shares similar hobbies (for example a sports team a book club)

0 1

S4 Participated in a community group with shared background characteristics (for example a Veterans organization momrsquos group)

0 1

Well-Being Inventory (05 August 2019) National Center for PTSD Page 20 of 23

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
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      606. Text Field 1
Page 19: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Participant ID

Everybody has aspects of their relationship that make them more or less happy Over the last 3 months how satisfied have you been with your significant otherrsquos contribution to the following aspects of your romantic relationship

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

O1Emotional closeness (for example sharing personal thoughts and feelings)

1 2 3 4 5

O2Companionship (for example doing enjoyable activities together)

1 2 3 4 5

O3Sexual and physical intimacy (for example holding hands or having sex)

1 2 3 4 5

O4 Intellectual connection (for example having many things to talk about)

1 2 3 4 5

O5Security (for example being able to trust and depend on partner)

1 2 3 4 5

O6Division of day-to-day tasks (for example your partnerrsquos contribution to chores and planning activities)

1 2 3 4 5

In this next section you will be asked about your parenting experiences

SECTION 4P

P1 Are you a parent or have you served in a parenting role during the past three months Yes No

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P2 Do you have children who are age 18 or younger Yes No

Well-Being Inventory (05 August 2019) National Center for PTSD Page 17 of 23

Participant ID

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P3 How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities) Enter a number on each line write 0 if you do not have any children in that age category

Number of Children

Under 5 years old

Age 5 through 12 years old

Age 13 through 18 years old

Age 19 through 26

27 years +

ADMINISTRATOR ASK OF THOSE WHO DO NOT INDICATE HAVING CHILDREN IN P1

P4 Which of the following is true with respect to your parenting status I would like to be a parent now I prefer not to be a parent at this time

SECTION 4Q

ADMINISTRATOR ASK OF ALL THOSE WHO HAVE CHILDREN UNDER 18 IN P2

Please answer the following questions with regard to children 18 or under for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 18 of 23

Participant ID

All parents have strengths and weaknesses Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

Q1Provided a healthy environment for your child(ren) (for example preparing healthy meals caring for their health keeping them safe)

1 2 3 4 5

Q2Been a good example for your child(ren) (for example being respectful during disagreements with others taking good care of your own health)

1 2 3 4 5

Q3Been actively involved in your child(ren)rsquos activities (for example regularly attending sporting and school events giving your full attention during time together)

1 2 3 4 5

Q4Met your child(ren)rsquos needs for physical affection and emotional support (for example giving them hugs being sympathetic to their problems)

1 2 3 4 5

Q5Been able to successfully manage your child(ren)rsquos unique challenges (for example efectively disciplining children)

1 2 3 4 5

SECTION 4R

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

Please answer the following questions with regard to ALL children for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 19 of 23

Participant ID

Parenting can be both rewarding and challenging How satisfed have you been with the following aspects of your parenting experiences over the last 3 months

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

R1 How close you are with your child(ren)

1 2 3 4 5

R2 How much enjoyment you get from parenting

1 2 3 4 5

R3 How your child(ren) are doing in life 1 2 3 4 5

SECTION 4S

ADMINISTRATOR ASK OF EVERYONE

In this next section you will be asked about your experiences in your broader community as well as your relationships with relatives and friends

Over the last 3 months have you regularly done the following

No Yes

S1 Participated in a religious or spiritual community

0 1

S2 Volunteered for a charity political group or other local organization (for example a service organization a political campaign)

0 1

S3 Participated in a community group that shares similar hobbies (for example a sports team a book club)

0 1

S4 Participated in a community group with shared background characteristics (for example a Veterans organization momrsquos group)

0 1

Well-Being Inventory (05 August 2019) National Center for PTSD Page 20 of 23

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
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      606. Text Field 1
Page 20: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Participant ID

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

P3 How many children do you have in the following age categories (including both your own biological children and other children for whom you have parenting responsibilities) Enter a number on each line write 0 if you do not have any children in that age category

Number of Children

Under 5 years old

Age 5 through 12 years old

Age 13 through 18 years old

Age 19 through 26

27 years +

ADMINISTRATOR ASK OF THOSE WHO DO NOT INDICATE HAVING CHILDREN IN P1

P4 Which of the following is true with respect to your parenting status I would like to be a parent now I prefer not to be a parent at this time

SECTION 4Q

ADMINISTRATOR ASK OF ALL THOSE WHO HAVE CHILDREN UNDER 18 IN P2

Please answer the following questions with regard to children 18 or under for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 18 of 23

Participant ID

All parents have strengths and weaknesses Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

Q1Provided a healthy environment for your child(ren) (for example preparing healthy meals caring for their health keeping them safe)

1 2 3 4 5

Q2Been a good example for your child(ren) (for example being respectful during disagreements with others taking good care of your own health)

1 2 3 4 5

Q3Been actively involved in your child(ren)rsquos activities (for example regularly attending sporting and school events giving your full attention during time together)

1 2 3 4 5

Q4Met your child(ren)rsquos needs for physical affection and emotional support (for example giving them hugs being sympathetic to their problems)

1 2 3 4 5

Q5Been able to successfully manage your child(ren)rsquos unique challenges (for example efectively disciplining children)

1 2 3 4 5

SECTION 4R

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

Please answer the following questions with regard to ALL children for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 19 of 23

Participant ID

Parenting can be both rewarding and challenging How satisfed have you been with the following aspects of your parenting experiences over the last 3 months

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

R1 How close you are with your child(ren)

1 2 3 4 5

R2 How much enjoyment you get from parenting

1 2 3 4 5

R3 How your child(ren) are doing in life 1 2 3 4 5

SECTION 4S

ADMINISTRATOR ASK OF EVERYONE

In this next section you will be asked about your experiences in your broader community as well as your relationships with relatives and friends

Over the last 3 months have you regularly done the following

No Yes

S1 Participated in a religious or spiritual community

0 1

S2 Volunteered for a charity political group or other local organization (for example a service organization a political campaign)

0 1

S3 Participated in a community group that shares similar hobbies (for example a sports team a book club)

0 1

S4 Participated in a community group with shared background characteristics (for example a Veterans organization momrsquos group)

0 1

Well-Being Inventory (05 August 2019) National Center for PTSD Page 20 of 23

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
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      229. Explain living situation
      230. Annual salary
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      606. Text Field 1
Page 21: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Participant ID

All parents have strengths and weaknesses Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

Q1Provided a healthy environment for your child(ren) (for example preparing healthy meals caring for their health keeping them safe)

1 2 3 4 5

Q2Been a good example for your child(ren) (for example being respectful during disagreements with others taking good care of your own health)

1 2 3 4 5

Q3Been actively involved in your child(ren)rsquos activities (for example regularly attending sporting and school events giving your full attention during time together)

1 2 3 4 5

Q4Met your child(ren)rsquos needs for physical affection and emotional support (for example giving them hugs being sympathetic to their problems)

1 2 3 4 5

Q5Been able to successfully manage your child(ren)rsquos unique challenges (for example efectively disciplining children)

1 2 3 4 5

SECTION 4R

ADMINISTRATOR ASK OF THOSE WHO INDICATE HAVING CHILDREN OR BEING IN A PARENTING ROLE IN P1

Please answer the following questions with regard to ALL children for whom you have parenting responsibilities

Well-Being Inventory (05 August 2019) National Center for PTSD Page 19 of 23

Participant ID

Parenting can be both rewarding and challenging How satisfed have you been with the following aspects of your parenting experiences over the last 3 months

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

R1 How close you are with your child(ren)

1 2 3 4 5

R2 How much enjoyment you get from parenting

1 2 3 4 5

R3 How your child(ren) are doing in life 1 2 3 4 5

SECTION 4S

ADMINISTRATOR ASK OF EVERYONE

In this next section you will be asked about your experiences in your broader community as well as your relationships with relatives and friends

Over the last 3 months have you regularly done the following

No Yes

S1 Participated in a religious or spiritual community

0 1

S2 Volunteered for a charity political group or other local organization (for example a service organization a political campaign)

0 1

S3 Participated in a community group that shares similar hobbies (for example a sports team a book club)

0 1

S4 Participated in a community group with shared background characteristics (for example a Veterans organization momrsquos group)

0 1

Well-Being Inventory (05 August 2019) National Center for PTSD Page 20 of 23

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
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      606. Text Field 1
Page 22: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Participant ID

Parenting can be both rewarding and challenging How satisfed have you been with the following aspects of your parenting experiences over the last 3 months

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

R1 How close you are with your child(ren)

1 2 3 4 5

R2 How much enjoyment you get from parenting

1 2 3 4 5

R3 How your child(ren) are doing in life 1 2 3 4 5

SECTION 4S

ADMINISTRATOR ASK OF EVERYONE

In this next section you will be asked about your experiences in your broader community as well as your relationships with relatives and friends

Over the last 3 months have you regularly done the following

No Yes

S1 Participated in a religious or spiritual community

0 1

S2 Volunteered for a charity political group or other local organization (for example a service organization a political campaign)

0 1

S3 Participated in a community group that shares similar hobbies (for example a sports team a book club)

0 1

S4 Participated in a community group with shared background characteristics (for example a Veterans organization momrsquos group)

0 1

Well-Being Inventory (05 August 2019) National Center for PTSD Page 20 of 23

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
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      606. Text Field 1
Page 23: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Over the last 3 months have you regularly done the following

No Yes

Participant ID

S5 Attended broader community social events (for example town road race music festival)

0 1

S6 Spent time with relatives other than your signifcan t other or children (for example getting together catching up by telephone or email)

0 1

S7 Spent time with close friends (for example getting together catching up by telephone or email)

0 1

SECTION 4T

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T1 Gotten along well with members of your community

1 2 3 4 5

T2 Followed the rules and expectations of your community (for example driving the speed limit being quiet in the evening and early morning hours)

1 2 3 4 5

T3 Helped out with your communityrsquos needs (for example assisting neighbors in need volunteering for community projects)

1 2 3 4 5

T4 Provided support or help to friends when needed

1 2 3 4 5

T5 Been available when friends wanted to spend time together

1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 21 of 23

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
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      547. T2-2 Off
      548. T2-3 Off
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      550. T2-5 Off
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      555. T3-5 Off
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      557. T4-2 Off
      558. T4-3 Off
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      562. T5-2 Off
      563. T5- Off
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      566. T6-1 Off
      567. T6-2 Off
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      570. T6-5 Off
      571. T7-1 Off
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      573. T7-3 Off
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      575. T7-5 Off
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      580. T8-5 Off
      581. T9-1 Off
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      585. T9-5 Off
      586. U1-1 Off
      587. U1-2 Off
      588. U1-3 Off
      589. U1-4 Off
      590. U1-5 Off
      591. U2-1 Off
      592. U2-2 Off
      593. U2-3 Off
      594. U2-4 Off
      595. U2-5 Off
      596. U3-1 Off
      597. U3-2 Off
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      600. U3-5 Off
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      606. Text Field 1
Page 24: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Participant ID

Over the last 3 months how often have you

Never Rarely Sometimes Often Most

or all of the time

T6 Gotten along well with friends 1 2 3 4 5

T7 Provided support or help to relatives other than your significant other or children when needed

1 2 3 4 5

T8 Been available when relatives other than your significant other or children wanted to spend time together

1 2 3 4 5

T9 Gotten along well with relatives other than your significant other or children

1 2 3 4 5

SECTION 4U

ADMINISTRATOR ASK OF EVERYONE

Over the last 3 months how satisfed ha ve you been with

Very dissatisfed

Somewhat dissatisfed

Neither satisfed

nor dissatisfed

Somewhat satisfed

Very satisfed

U1 The area where you live (for example available resources safety)

1 2 3 4 5

U2 Your sense of belonging in your community

1 2 3 4 5

U3 Your relationships with relatives other than your significant other or children

1 2 3 4 5

U4 Your relationships with friends 1 2 3 4 5

Well-Being Inventory (05 August 2019) National Center for PTSD Page 22 of 23

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
      1. A1-1 Off
      2. A1-2 Off
      3. A1-3 Off
      4. A2-1
      5. A3-1 Off
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      14. A5-1 Off
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      34. Other3
      35. A6-1 Off
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      38. Year1
      39. Months1
      40. A8-1 Off
      41. A8-2 Off
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      45. A9-1 Off
      46. A9-2 Off
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      86. Other7
      87. Never1 Off
      88. Never2 Off
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      90. Rarely1 Off
      91. Sometimes1 Off
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      94. Most or all of the time1 Off
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      96. Most or all of the time2 Off
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      159. tech1
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      180. E2- Off
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      227. G8- Off
      228. Somewhere Off
      229. Explain living situation
      230. Annual salary
      231. Hourly
      232. estimate
      233. readily available
      234. expenses
      235. H1-1 Off
      236. H1-2 Off
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      311. J3-13 Off
      312. Specify other problem1
      313. Specify other problem2
      314. Specify other problem3
      315. J3-14 Off
      316. J3-15 Off
      317. J4-1 Off
      318. J4-2 Off
      319. J5-1 Off
      320. J5-2 Off
      321. J5-3 Off
      322. J5-4 Off
      323. J5-5 Off
      324. J5-6 Off
      325. J5-7 Off
      326. J5-8 Off
      327. Other9
      328. K1-1 Off
      329. K1-2 Off
      330. K1-3 Off
      331. K1-4 Off
      332. K1-5 Off
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      334. K2-2 Off
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      336. K2-4 Off
      337. K2-5 Off
      338. K3-1 Off
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      340. K3-3 Off
      341. K3-4 Off
      342. K3-5 Off
      343. K4-1 Off
      344. K4-2 Off
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      346. K4-4 Off
      347. K4-5 Off
      348. K5-1 Off
      349. K5-2 Off
      350. K5-3 Off
      351. K5-4 Off
      352. K5-5 Off
      353. K6-1 Off
      354. K6-2 Off
      355. K6-3 Off
      356. K6-4 Off
      357. K6-5 Off
      358. K7-1 Off
      359. K7-2 Off
      360. K7- Off
      361. K7-4 Off
      362. K7-5 Off
      363. K8-1 Off
      364. K8-2 Off
      365. K8-3 Off
      366. K8-4 Off
      367. K8-5 Off
      368. K9-1 Off
      369. K9-2 Off
      370. K9-3 Off
      371. K9-4 Off
      372. K9-5 Off
      373. K10-1 Off
      374. K10-2 Off
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      376. K10-4 Off
      377. K10-5 Off
      378. K11-1 Off
      379. K11-2 Off
      380. K11-3 Off
      381. K11-4 Off
      382. K11-5 Off
      383. K12-1 Off
      384. K12-2 Off
      385. K12-3 Off
      386. K12-4 Off
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      388. L1-1 Off
      389. L1-2 Off
      390. L1-3 Off
      391. L1-4 Off
      392. L1-5 Off
      393. L2-1 Off
      394. L2-2 Off
      395. L2-3 Off
      396. L2-4 Off
      397. L2-5 Off
      398. L3-1 Off
      399. L3-2 Off
      400. L3-3 Off
      401. L3-4 Off
      402. L3-5 Off
      403. M1-1 Off
      404. M1-2 Off
      405. M1-3 Off
      406. M1-4 Off
      407. M1-5 Off
      408. M1-6 Off
      409. M2-1 Off
      410. M2-2 Off
      411. M2-3 Off
      412. year2
      413. months2
      414. M4-1 Off
      415. M4-2 Off
      416. N1-1 Off
      417. N1-2 Off
      418. N1-3 Off
      419. N1-4 Off
      420. N1-5 Off
      421. N2-1 Off
      422. N2-2 Off
      423. N2-3 Off
      424. N2-4 Off
      425. N2-5 Off
      426. N3-1 Off
      427. N3-2 Off
      428. N3-3 Off
      429. N3-4 Off
      430. N3-5 Off
      431. N4-1 Off
      432. N4-2 Off
      433. N4-3 Off
      434. N4- Off
      435. N4-5 Off
      436. N5-1 Off
      437. N5-2 Off
      438. N5-3 Off
      439. N5- Off
      440. N5-5 Off
      441. N6-1 Off
      442. N6-2 Off
      443. N6-3 Off
      444. N6-4 Off
      445. N6-5 Off
      446. O1-1 Off
      447. O1-2 Off
      448. O1-3 Off
      449. O1-4 Off
      450. O1-5 Off
      451. O2-1 Off
      452. O2-2 Off
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      454. O2-4 Off
      455. O2-5 Off
      456. O3-1 Off
      457. O3-2 Off
      458. O3-3 Off
      459. O3-4 Off
      460. O3-5 Off
      461. O4-1 Off
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      463. O4-3 Off
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      467. O5-2 Off
      468. O5-3 Off
      469. O5-4 Off
      470. O5-5 Off
      471. O6-1 Off
      472. O6-2 Off
      473. O6-3 Off
      474. O6-4 Off
      475. O6-5 Off
      476. P1-1 Off
      477. P1-2 Off
      478. P2-1 Off
      479. P2-2 Off
      480. Children1
      481. Children2
      482. Children3
      483. Children4
      484. Children5
      485. P4-1 Off
      486. P4-2 Off
      487. Q1-1 Off
      488. Q1-2 Off
      489. Q1-3 Off
      490. Q1-4 Off
      491. Q1-5 Off
      492. Q2-1 Off
      493. Q2-2 Off
      494. Q2-3 Off
      495. Q2-4 Off
      496. Q2-5 Off
      497. Q3-1 Off
      498. Q3-2 Off
      499. Q3-3 Off
      500. Q3-4 Off
      501. Q3-5 Off
      502. Q4-1 Off
      503. Q4-2 Off
      504. Q4-3 Off
      505. Q4-4 Off
      506. Q4-5 Off
      507. Q5-1 Off
      508. Q5-2 Off
      509. Q5-3 Off
      510. Q5-4 Off
      511. Q5-5 Off
      512. R1-1 Off
      513. R1-2 Off
      514. R1-3 Off
      515. R1- Off
      516. R1-5 Off
      517. R2-1 Off
      518. R2-2 Off
      519. R2-3 Off
      520. R2-4 Off
      521. R2-5 Off
      522. R3-1 Off
      523. R3-2 Off
      524. R3-3 Off
      525. R3-4 Off
      526. R3-5 Off
      527. S1-1 Off
      528. S1-2 Off
      529. S2-1 Off
      530. S2-2 Off
      531. S3-1 Off
      532. S3-2 Off
      533. S4-1 Off
      534. S4-2 Off
      535. S5-1 Off
      536. S5-2 Off
      537. S6-1 Off
      538. S6-2 Off
      539. S7-1 Off
      540. S7-2 Off
      541. T1-1 Off
      542. T1-2 Off
      543. T1-3 Off
      544. T1-4 Off
      545. T1-5 Off
      546. T2-1 Off
      547. T2-2 Off
      548. T2-3 Off
      549. T2-4 Off
      550. T2-5 Off
      551. T3-1 Off
      552. T3-2 Off
      553. T3-3 Off
      554. T3-4 Off
      555. T3-5 Off
      556. T4-1 Off
      557. T4-2 Off
      558. T4-3 Off
      559. T4-4 Off
      560. T4-5 Off
      561. T5-1 Off
      562. T5-2 Off
      563. T5- Off
      564. T5-4 Off
      565. T5-5 Off
      566. T6-1 Off
      567. T6-2 Off
      568. T6-3 Off
      569. T6-4 Off
      570. T6-5 Off
      571. T7-1 Off
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      573. T7-3 Off
      574. T7-4 Off
      575. T7-5 Off
      576. T8-1 Off
      577. T8-2 Off
      578. T8-3 Off
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      580. T8-5 Off
      581. T9-1 Off
      582. T9-2 Off
      583. T9-3 Off
      584. T9-4 Off
      585. T9-5 Off
      586. U1-1 Off
      587. U1-2 Off
      588. U1-3 Off
      589. U1-4 Off
      590. U1-5 Off
      591. U2-1 Off
      592. U2-2 Off
      593. U2-3 Off
      594. U2-4 Off
      595. U2-5 Off
      596. U3-1 Off
      597. U3-2 Off
      598. U3-3 Off
      599. U3-4 Off
      600. U3-5 Off
      601. U4-1 Off
      602. U4-2 Off
      603. U4-3 Off
      604. U4-4 Off
      605. U4-5 Off
      606. Text Field 1
Page 25: Well-Being Inventory (WBI)Participant ID# Well-Being Inventory Instructions: This inventory contains questions regarding your experiences in the key life domains of vocation (work,

Participant ID

Support for the development and validation of the Well-Being Inventory (WBI) was provided by the National Center for Posttraumatic Stress Disorder as well as the Veteran Metrics Initiative Study which is managed by the

Henry M Jackson Foundation for the Advancement of Military Medicine Inc

For inquiries or further information please contact Dr Dawne Vogt at the National Center for PTSD VA Boston Healthcare System 150 S Huntington Ave Boston MA 02130 Phone (857) 364-5976

DawneVogtvagov

Well-Being Inventory (05 August 2019) National Center for PTSD Page 23 of 23

  • Well-Being Inventory (WBI)
  • Note to Test Administrators
  • Well-Being Inventory Instructions
  • SECTION 1 VOCATION (WORK AND EDUCATION)
  • SECTION 1A
  • SECTION 1B
  • SECTION 1C
  • SECTION 1D
  • SECTION 1E
  • SECTION 1F
  • SECTION 2 FINANCES
  • SECTION 2G
  • SECTION 2H
  • SECTION 2I
  • SECTION 3 CURRENT HEALTH
  • SECTION 3J
  • SECTION 3K
  • SECTION 3L
  • SECTION 4 SOCIAL RELATIONSHIPS
  • SECTION 4M
  • SECTION 4N
  • SECTION 4O
  • SECTION 4P
  • SECTION 4Q
  • SECTION 4R
  • SECTION 4S
  • SECTION 4T
  • SECTION 4U
  • For inquiries or further information
      1. A1-1 Off
      2. A1-2 Off
      3. A1-3 Off
      4. A2-1
      5. A3-1 Off
      6. A3-2 Off
      7. A4-1 Off
      8. A4-2 Off
      9. A4-3 Off
      10. A4-4 Off
      11. A4-5 Off
      12. A4-6 Off
      13. Other2
      14. A5-1 Off
      15. A5-2 Off
      16. A5-3 Off
      17. A5-4 Off
      18. A5-5 Off
      19. A5-6 Off
      20. A5-7 Off
      21. A5-8 Off
      22. A5-9 Off
      23. A5-10 Off
      24. A5-11 Off
      25. A5-12 Off
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      27. A5-14 Off
      28. A5-15 Off
      29. A5-16 Off
      30. A5-17 Off
      31. A5-18 Off
      32. A5-19 Off
      33. A5-20 Off
      34. Other3
      35. A6-1 Off
      36. A6-2 Off
      37. A6-3 Off
      38. Year1
      39. Months1
      40. A8-1 Off
      41. A8-2 Off
      42. A8-3 Off
      43. A8-4 Off
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      233. readily available
      234. expenses
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      412. year2
      413. months2
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      415. M4-2 Off
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      417. N1-2 Off
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      419. N1-4 Off
      420. N1-5 Off
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      427. N3-2 Off
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      432. N4-2 Off
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      434. N4- Off
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      436. N5-1 Off
      437. N5-2 Off
      438. N5-3 Off
      439. N5- Off
      440. N5-5 Off
      441. N6-1 Off
      442. N6-2 Off
      443. N6-3 Off
      444. N6-4 Off
      445. N6-5 Off
      446. O1-1 Off
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      472. O6-2 Off
      473. O6-3 Off
      474. O6-4 Off
      475. O6-5 Off
      476. P1-1 Off
      477. P1-2 Off
      478. P2-1 Off
      479. P2-2 Off
      480. Children1
      481. Children2
      482. Children3
      483. Children4
      484. Children5
      485. P4-1 Off
      486. P4-2 Off
      487. Q1-1 Off
      488. Q1-2 Off
      489. Q1-3 Off
      490. Q1-4 Off
      491. Q1-5 Off
      492. Q2-1 Off
      493. Q2-2 Off
      494. Q2-3 Off
      495. Q2-4 Off
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      498. Q3-2 Off
      499. Q3-3 Off
      500. Q3-4 Off
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      504. Q4-3 Off
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      506. Q4-5 Off
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      511. Q5-5 Off
      512. R1-1 Off
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      514. R1-3 Off
      515. R1- Off
      516. R1-5 Off
      517. R2-1 Off
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      541. T1-1 Off
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      606. Text Field 1

Modelling Economic Well-Being and Social Well-Being for

Corporate Well-Being

EFFECTS OF THINKING STYLES AND GENDER ON … · well-being literature designated two dimensions for well-being which are subjective and psychological well-being. Subjective well-being

Being Well

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Family well-being is valued more than personal well-being ... · Family well-being is valued more than personal well-being: A four-country study Kuba Krys1,2 & Colin A. Capaldi3 &

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Chart Your Course Towards Community Well-being · What is “Well-being?” ! Well-being refers to the presence of the highest possible quality of life … (Canadian Index of Well-Being)!

Estimating Well-Being in Developing Countries. Well-Being (1) What is well-being? (2) Why should economists be interested in well-being? (3)Estimating

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Psychological Well-being and Young People INTRODUCTION PSYCHOLOGICAL WELL-BEING Psychological Well-being Ageing Physical Health and Mental Health Psychological

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CHILD WELL-BEING REPORT FY16 - F17 Report... · CHILD WELL-BEING REPORT FY16 FY17 CHILD WELL-BEING REPORT FY16 - F17. CHILD WELL-BEING REPORT FY16–FY17 World Vision Albania & Kosovo

Community Well-Being

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Well-Being, Well Done

Total Well being

Community, Comparisons and Subjective Well-being in · PDF fileCommunity, Comparisons and Subjective Well-being in a ... Comparisons and Subjective Well-being in a ... well-being is

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NATIONAL FOREST INVENTORY FIELD MANUALNational Forest Inventory - Field Manual 2 The Forest Resources Assessment Programme Forests are crucial for the well being of humanity. They

Employee well-being

Voices on well-being Jennie Fleming. What does the term ‘well-being’ mean to you? How does well-being feel? How do you achieve well-being? What are the

Family well-being is valued more than personal well …...Keywords Family .Happiness .Well-being .Interdependenthappiness .Lifesatisfaction .Culturalpsychology The recognition of well-being

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WELL-BEING TOOLKIT - Minnesotalprb.mncourts.gov/LawyerResources/Pages/Well-Being... · Lawyer Well-Being Tool Kit / 3 TABLE OF CONTENTS IntroductIon 4 defInItIon of Lawyer weLL-BeIng7